Epidemiology of childhood tuberculosis and factors associated with unsuccessful treatment outcomes in Tigray, Ethiopia: a ten-year retrospective cross sectional study

Abstract

BackgroundChildhood TB is an indicator of a recent transmission of the disease in a community and it is estimated to constitute 15–20% of all TB cases in many of developing countries. However, only few studies which dominated by industrial countries were engaged to assess the situation. Therefore, this study was aimed to see epidemiology of childhood TB and factors associated with poor treatment outcome in developing country.MethodUsing retrospective cross-sectional study design; Socio-demographic and clinical data of children aged less than 15 years old, treated for all forms of TB in the past 10 years (2007–2016) was collected from randomly selected eight public hospitals of Tigray. Then, Univariate logistic regression and adjusted multivariate logistic regressions was done to identify variables which had association with unsuccessful treatment outcomes at P-value less than 0.05.ResultIn the past 10 years, a total of 13,345 Tuberculosis cases were observed. Of these, 1086 (8.1%) cases were children aged less than 15 years old. Sixty seven (6.2%) cases were smear positive. Among those that tested for HIV, 69 (8.3%) cases were TB/HIV co-infected. Of those with treatment outcome record 746 (88.7%) were successfully treated. Factors like being female (AOR, 1.79; 95% CI, 1.07–3.00), Age 0–5 years (AOR, 3.35; 95% CI, 2.11–5.33), Unknown HIV status (AOR, 2.44; 95% CI, 1.51–3.95) and pulmonary positive case (AOR, 2.56; 95% CI, 1.13–5.77), were more likely to have unsuccessful treatment outcome than their counterparts.ConclusionIn Tigray 8.1% all TB cases were children age less than 15 years old. Childhood TB treatment outcome varied with sex, age and HIV status.

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro

“…In the multivariate analysis, HIV infection was the only variable independentlyassociated with the treatment outcome, with a risk of unfavorable outcome 2.5 times higher among children infected with HIV. Children with TB-HIV co-infection or unknown HIV status have a higher risk of death, adverse drug reactions, and treatment default (Kay et al, 2018;Jenkins et al, 2017;Mirutse et al, 2019). Similar results have been described in Brazil, where TB-HIV co-infected children are more likely to be institutionalized, readmitted after treatment default, and to have unfavorable outcomes (default and death) (Dos Santos Dias et al, 2015).…”

Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis

“…The low treatment success rate of this study compared with WHO 2020 report may be attributed to the fact that nearly all of the studies included in this meta-analysis were among the three high TB-burden countries countries [7,9,10,13,14,[26][27][28][29][30]32,33,[36][37][38][39][40][41][42][43][44][45] and countries with high TB/HIV co-infection [25,31]. More than one-fives of the analyzed studies were also conducted before and during 2015 [9,[32][33][34][35][36].…”

“…A total of 306,351 study participants with a sample size ranging from 227 in Ethiopia [41] to 170,017 in South Africa [37]; for studies conducted in Ethiopia and South Africa respectively. Most of the study populations were from regions that are currently listed under the WHO as high TB burden countries [7,9,10,13,14,[26][27][28][29][30]32,33,[36][37][38][39][40][41][42][43][44][45].…”

“…The demographic and clinical factors expected to have a relationship with the TB treatment success rate were assessed. The association of HIV co-infection and retreatment status were assessed using 19 articles [7,9,13,14,[25][26][27]29,30,32,33,[38][39][40][41][42][43][44][45] reported tractable data on HIV co-infection and 11 articles [9,14,29,[32][33][34]36,[38][39][40][41] with data on retreatment used for analysis. Accordingly, the overall pooled and region-based subgroup estimates indicated that HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcome; as compared to HIV negative and newly diagnosed TB patients with RR of 95% CI: (1.53 (1.36, 1.71)) and (1.48 (1.14, 1.94)), respectively (Figures 3 and 4).…”

<p>Rifampicin-Resistant <em>Mycobacterium tuberculosis</em> Among Patients with Presumptive Tuberculosis in Addis Ababa, Ethiopia</p>

“…3 A mathematical modeling study of burden of childhood TB in 22 high-burden countries showed that the predicted proportion of tuberculosis burden in children for each country is correlated with incidence, varying between 4% and 21%. 28 Although the national burden of childhood tuberculosis is not known in Ethiopia, retrospective studies conducted in Tigray region, Northern Ethiopia 31 and Southern Ethiopia 32 showed 8.1% and 13% among all notified tuberculosis cases, respectively.…”