Epidemiology of Pediatric Tuberculosis in Kenya and Risk Factors for Mortality during Treatment: A National Retrospective Cohort Study

Onyango, Dickens; Yuen, Courtney M.; Masini, Enos; Borgdorff, Martien W.

doi:10.1016/j.jpeds.2018.05.017

Cited by 28 publications

(35 citation statements)

References 21 publications

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“…Presence of low Apgar scores and low birthweight at the time of delivery were associated with higher mortality risk among infants and children in our cohort. Consistent with prior studies conducted in outpatient settings [21,22], we found higher rates of mortality among HIV-infected infants and children compared to those who were HIV-negative. Previous work has demonstrated that child factors such as young age, malnutrition, and advanced WHO HIV staging may contribute to greater mortality among children with HIV compared to children who are not infected [23][24][25].…”

Section: Discussionsupporting

confidence: 90%

Risk factors for mortality among Tanzanian infants and children

et al. 2020

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Background: During the era of the Millennium Development Goals, under 5 mortality rates decreased significantly worldwide; however, reductions were not equally distributed. Children in sub-Saharan Africa still account for more than 50% of the world's annual childhood deaths among children under 5 years of age. Understanding upstream risk factors for mortality among children may reduce the large burden of childhood mortality in sub-Saharan Africa. Our objective was to identify risk factors for mortality among infants and children in Tanzania. Methods: We conducted a secondary analysis of data pooled from two randomized-controlled micronutrient supplementation trials. A total of 4787 infants were enrolled in the two trials (n = 2387 HIV-exposed and n = 2400 HIV-unexposed). Predictors of mortality were assessed using unadjusted and adjusted hazard ratios (aHRs). Results: There were 307 total deaths, 262 (11%) among children who were HIV-exposed and 45 (2%) among children who were HIV-unexposed (P < 0.001). The most common cause of death was respiratory diseases (n = 109, 35.5%). Causes of death did not significantly differ between HIV-exposed and HIV-unexposed children. In adjusted regression analyses, children with birth weight <2500 g (aHR 1.75, 95% CI 1.21-2.54), Apgar score of ≤7 at 5 min (aHR 2.16, 95% CI 1.29-3.62), or who were HIV-exposed but not infected (aHR 3.35, 95% CI 2.12-5.28) or HIV-infected (aHR 27.56, 95% CI 17.43-43.58) had greater risk of mortality. Conclusions: Infection with HIV, low birthweight, or low Apgar scores were associated with higher mortality risk. Early identification and modification of determinants of mortality among infants and children may be the first step to reducing such deaths.

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Section: Discussionsupporting

confidence: 90%

Risk factors for mortality among Tanzanian infants and children

et al. 2020

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“…In 2016 alone, the SSA region accounted for an estimated 86% of HIVlinked TB deaths (18). Kenya is one of the countries in SSA severely hit by the dual epidemic and appears among the WHO high TB and TB-HIV burden countries ranking 13 out of the 22 countries globally (19,20).…”

Section: Introductionmentioning

confidence: 99%

Bayesian Modeling of Spatiotemporal patterns of TB-HIV co-infection risk in Kenya

Otiende

Achia

Mwambi

2019

Preprint

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Background Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) diseases are globally acknowledged as a public health challenge that exhibits adverse bidirectional relations due to the co-epidemic overlap. To understand the co-infection burden we used the case notification data to generate spatiotemporal maps that described the distribution and exposure hypotheses for further epidemiologic investigations in areas with unusual case notification levels. Methods We analyzed the TB and TB-HIV case notification data from the Kenya national TB control program aggregated for forty-seven counties over a seven-year period (2012 – 2018). Using the Integrated Nested Laplace Approach (INLA), we modeled the risk of TB-HIV co-infection. Six competing models with varying space-time formulations were compared to determine the best fit model. We then assessed the geographic patterns and temporal trends of coinfection risk by mapping the posterior marginal from the best fit model. Results Of the total 608312 TB case notifications, 194129 were HIV co-infected. The proportion of TB-HIV co-infection was higher in females (39.7%) than in males (27.0%). A significant share of the co-infection was among adults aged 35 to 44 years (46.7%) and 45 to 54 years (42.1%). Based on the Bayesian Defiance Information (DIC) and the effective number of parameters comparisons, the spatiotemporal model 3b was the best in explaining the geographical variations in TB-HIV coinfection. The model results suggested that the risk of TB-HIV coinfection was influenced by infrastructure index (Relative risk (RR)=5.75, Credible Interval (Cr.I) = (1.65, 19.89)) and gender ratio . The lowest and highest temporal relative risks were in the years 2016 at 0.9 and 2012 at 1.07 respectively. The spatial pattern presented an increased co-infection risk in a number of counties. For the spatiotemporal interaction, only a few counties had a relative risk greater than 1 that varied in different years. Conclusions We identified elevated risk areas for TB/HIV co-infection and fluctuating temporal trends which could be because of improved TB case detection or surveillance bias caused by spatial heterogeneity in the co-infection dynamics. Focused interventions and continuous TB-HIV surveillance will ensure adequate resource allocation and significant reduction of HIV burden amongst TB patients

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“…Owing to the lack of individual-level data regarding the efficacy of the regimens in terms of improved pediatric TB treatment outcomes, WHO prequalification of the FDCs is the quality indicator for the purpose of this impact evaluation. Having first endorsed the FDCs in March 2017, the WHO and UNICEF released a joint statement urging “all national TB programmes to discontinue and replace the previously used medicines for children weighing <25 kg with the child-friendly dispersible TB FDCs as soon as possible” [ 4 ]. Moreover, the new child-friendly FDCs are now included on the most recent iteration of the WHO List of Essential Medicines for Children, whereas previous FDCs are not [ 1 , 5 ].…”

Section: Case Study Resultsmentioning

confidence: 99%

“…Children are, however, at increased risk of progression to active TB disease, making accurate diagnosis and prompt treatment initiation crucial in this group [4]. Moreover, TB treatment in children is considered critical to the attainment of the Sustainable Development Goal of ending preventable deaths in children by 2030.…”

Section: Introductionmentioning

confidence: 99%

“…Unfortunately, addressing childhood TB has not been a priority in the past in comparison to TB in adults [ 1 ], and TB control in children is hindered by the fact that accurate diagnosis of TB in children remains a challenge. Children are, however, at increased risk of progression to active TB disease, making accurate diagnosis and prompt treatment initiation crucial in this group [ 4 ]. Moreover, TB treatment in children is considered critical to the attainment of the Sustainable Development Goal of ending preventable deaths in children by 2030.…”

Section: Introductionmentioning

confidence: 99%

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The Roll-out of Child-friendly Fixed-dose Combination TB Formulations in High-TB-Burden Countries: A Case Study of STEP-TB

Faust¹,

Abdi²,

Davis³

et al. 2019

JEGH

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A B S T R A C TChildhood tuberculosis (TB) has hitherto been treated through estimation of pediatric doses through the crushing of adult pills, but the bitter taste of the pills and the inaccuracy of this dosing method presents a challenge for both patients and healthcare providers, leading to poor treatment outcomes. The TB Alliance therefore launched the Speeding Treatments to End Pediatric-Tuberculosis (STEP-TB) project to incentivize the introduction of pediatric Fixed-Dose Combinations (FDCs) of TB drugs. This case study describes the elements of this project, evaluates its impact, and highlights future challenges for pediatric TB treatment. The impact assessment incorporates both market impact as well as projected public health impact, evaluating the availability, affordability, and quality of the FDCs, and lastly providing a projection of lives saved as a result of scale-up of the FDCs to near-universal availability and utilization, based on a publicly available pediatric TB-specific model. STEP-TB resulted in the development of two child-friendly FDCs that were successfully brought to market and made available in 20 of the project's 22 high-burden countries. On the basis of a country-specific projection of pediatric TB mortality in Kenya, scale-up to nearuniversal availability and utilization of the new FDCs could reduce pediatric TB-associated mortality by 2660 cases over the next 5 years. Future challenges include maintaining affordable prices for the FDCs and considering mechanisms to incentivize their introduction among high-risk groups in low-burden countries.

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Epidemiology of Pediatric Tuberculosis in Kenya and Risk Factors for Mortality during Treatment: A National Retrospective Cohort Study

Cited by 28 publications

References 21 publications

Risk factors for mortality among Tanzanian infants and children

Risk factors for mortality among Tanzanian infants and children

Bayesian Modeling of Spatiotemporal patterns of TB-HIV co-infection risk in Kenya

The Roll-out of Child-friendly Fixed-dose Combination TB Formulations in High-TB-Burden Countries: A Case Study of STEP-TB

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