Burden, spectrum and outcomes of children with tuberculosis diagnosed at a district-level hospital in South Africa

Preez, Karen Du; Plessis, L. Du; O’Connell, Natasha; Hesseling, Anneke C.

doi:10.5588/ijtld.17.0893

Cited by 13 publications

(12 citation statements)

References 25 publications

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“…At a district-level hospital, comparable results were achieved by only one dedicated lay health care worker for referral support and follow-up, provided surveillance was done by routine clinical personnel; 93 (96%) of child TB cases successfully accessed PHC care and 89 (90%) were matched in the ETR.Net/EDRWeb. 15 In settings where information technology infrastructure is available, automated, electronic processes at hospital discharge could greatly assist with surveillance and linking of important referral processes, but will still rely on personnel at the referral hospital to provide sufficient information and the receiving facility to act on the information. Another potential solution to close this reporting gap would be to mandate all hospitals to report TB data.…”

Section: Discussionmentioning

confidence: 99%

“…Childhood TB, especially TB in young children, is often diagnosed at hospital level due to challenges faced in specimen collection and diagnosis. 14,15 A retrospective audit of children diagnosed with culture-confirmed TB during 2007-2009 at a large tertiary hospital in Cape Town, Western Cape Province, South Africa, found an overall reporting gap of 38% (101/267); 32% (58/183) among children discharged home to continue TB care. 16 Given the large number of children with TB managed at this hospital (approximately 400 per year) 14 and other referral centres, this underestimation of the burden and spectrum of TB disease can have a considerable impact on resource allocation and service delivery.…”

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confidence: 99%

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Closing the reporting gap for childhood tuberculosis in South Africa: improving hospital referrals and linkages

Preez

Schaaf

Dunbar

et al. 2020

public health action

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Setting: A referral hospital in Cape Town, Western Cape Province, Republic of South Africa.Objective: To measure the impact of a hospital-based referral service (intervention) to reduce initial loss to follow-up among children with tuberculosis (TB) and ensure the completeness of routine TB surveillance data.Design: A dedicated TB referral service was established in the paediatric wards at Tygerberg Hospital, Cape Town, in 2012. Allocated personnel provided TB education and counselling, TB referral support and weekly telephonic follow-up after hospital discharge. All children identified with TB were matched to electronic TB treatment registers (ETR.Net/EDRWeb). Multivariable logistic regression was used to compare reporting of culture-confirmed and drug-susceptible TB cases before (2007–2009) and during (2012) the intervention.Results: Successful referral with linkage to care was confirmed in 267/272 (98%) and successful reporting in 227/272 (84%) children. Children with drug-susceptible, culture-confirmed TB were significantly more likely to be reported during the intervention period than in the pre-intervention period (OR 2.52, 95%CI 1.33–4.77). The intervention effect remained consistent in multivariable analysis (adjusted OR 2.62; 95%CI 1.31–5.25) after adjusting for age, sex, human immunodeficiency virus status and the presence of TB meningitis.Conclusions: A simple hospital-based TB referral service can reduce initial loss to follow-up and improve recording and reporting of childhood TB in settings with decentralised TB services.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Closing the reporting gap for childhood tuberculosis in South Africa: improving hospital referrals and linkages

Preez

Schaaf

Dunbar

et al. 2020

public health action

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“…While the proportion with favorable outcome was below the global target, it corresponds with child TB outcomes in similar settings [16]. Retrospective studies in Nigeria, South Africa and Ethiopia found child TB (confirmed and clinically diagnosed) success rates of 77.4% [17], 78% [18], and 85.5% [19, 20], respectively. We also found a similar favorable proportion among the confirmed child TB cases.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010–2015

Wobudeya

Jaganath

Sekadde³

et al. 2019

BMC Public Health

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Background Childhood tuberculosis (TB) diagnoses often lack microbiologic confirmation and require empiric treatment. Barriers to empiric treatment include concern for poor outcomes and adverse effects. We thus determined the outcomes of empiric TB treatment from a retrospective cohort of children at a national referral hospital in Kampala, Uganda from 2010 to 2015. Methods Children were diagnosed clinically and followed through treatment. Demographics, clinical data, outcome and any adverse events were extracted from patient charts. A favorable outcome was defined as a child completing treatment with clinical improvement. We performed logistic regression to assess factors associated with loss to follow up and death. Results Of 516 children, median age was 36 months (IQR 15–73), 55% (95% CI 51–60%) were male, and HIV prevalence was 6% (95% CI 4–9%). The majority ( n = 422, 82, 95% CI 78–85%) had a favorable outcome, with no adverse events that required treatment discontinuation. The most common unfavorable outcomes were loss to follow-up (57/94, 61%) and death (35/94, 37%; overall mortality 7%). In regression analysis, loss to follow up was associated with age 10–14 years (OR 2.38, 95% CI 1.15–4.93, p = 0.02), HIV positivity (OR 3.35, 95% CI 1.41–7.92, p = 0.01), hospitalization (OR 4.14, 95% CI 2.08–8.25, p < 0.001), and living outside of Kampala (OR 2.64, 95% CI 1.47–4.71, p = 0.001). Death was associated with hospitalization (OR 4.57, 95% CI 2.0–10.46, p < 0.001), severe malnutrition (OR 2.98, 95% CI 1.07–8.27, p = 0.04), baseline hepatomegaly (OR 4.11, 95% CI 2.09–8.09, p < 0.001), and living outside of Kampala (OR 2.41, 95% CI 1.17–4.96, p = 0.02). Conclusions Empiric treatment of child TB was effective and safe, but treatment success remained below the 90% target. Addressing co-morbidities and improving retention in care may reduce unfavorable outcomes.

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“…Al igual que lo descrito en otros estudios, dentro de las presentaciones de TBCEP, predominó la TBC pleural, seguida de SNC y linfoganglionar, siendo poco frecuentes la TBC cutánea, ósea y peritoneal 6,7,21 .…”

Section: Discussionunclassified

Tuberculosis extra-pulmonar en niños bajo 15 años de edad internados en el Centro Hospitalario Pereira Rossell, Uruguay

Martínez

Vázquez

Flores

et al. 2020

Rev. chil. infectol.

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Burden, spectrum and outcomes of children with tuberculosis diagnosed at a district-level hospital in South Africa

Cited by 13 publications

References 25 publications

Closing the reporting gap for childhood tuberculosis in South Africa: improving hospital referrals and linkages

Closing the reporting gap for childhood tuberculosis in South Africa: improving hospital referrals and linkages

Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010–2015

Tuberculosis extra-pulmonar en niños bajo 15 años de edad internados en el Centro Hospitalario Pereira Rossell, Uruguay

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