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

Wobudeya, Eric; Jaganath, Devan; Sekadde, Moorine Penninah; Nsangi, Betty; Haq, Heather; Cattamanchi, Adithya

doi:10.1186/s12889-019-6821-2

Cited by 26 publications

(22 citation statements)

References 18 publications

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“…Over half of the articles (61.5%) used cohort study design [7,9,13,14,[25][26][27][28][29][30][31][32][33][34][35][36] whereas the rest 38.8% were retrospective cross-sectional studies [10,[37][38][39][40][41][42][43][44] (Table 1). 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.…”

Section: Characteristics Of Study Setting and Contextmentioning

confidence: 99%

“…The majority 163,126 (53.2%) of patients were male. Because of the two largest studies that included settings with a high prevalence of TB/HIV co-infection [25,31], the proportion of TB-HIV co-infection participants were extremely higher 165,551 (54.0%). The percentage of retreatment cases compared to newly diagnosed TB patients was found to be reasonable, with about 16,492 (5.4%) of the total participants included in the current study.…”

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

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

Teferi

El‐Khatib

Boltena

et al. 2021

IJERPH

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This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute’s (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran’s Q test and I2 statistic. Publication bias was checked using the funnel plot and egger’s test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76–82%), ranging from 53% (95% CI: 47–58%) in Nigeria to 92% (95% CI: 90–93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40–57%) death and 47% (95% CI: 39–55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36–1.71) and 1.48 (95% CI: 1.14–1.94) respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs.

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Section: Characteristics Of Study Setting and Contextmentioning

confidence: 99%

Section: Characteristics Of the Study Populationmentioning

confidence: 99%

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

Teferi

El‐Khatib

Boltena

et al. 2021

IJERPH

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“…Among the subgroup of children who are diagnosed with TB disease and who are successfully initiated on appropriate TB treatment, there are several previously identified factors that may increase a child’s risk of experiencing an unsuccessful treatment outcome, including death or loss to follow-up. Children who are less than five years old [ 9 - 15 ], have HIV co-infection [ 10 , 11 , 13 , 16 - 19 ], have a low body weight [ 18 , 20 ], and are bacteriologically positive [ 9 , 19 , 21 ] have an increased risk of experiencing unsuccessful treatment outcomes. While individual-level predictors have been assessed for their predictive ability of treatment outcomes in several studies, there is limited evidence on the role of facility-level characteristics and disease presentation, such as examination findings for TB disease.…”

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confidence: 99%

Predictors of unsuccessful tuberculosis treatment outcomes in children from a prospective cohort study in Pakistan

et al. 2021

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Background Every year, about 239 000 children die from tuberculosis (TB), despite availability of highly effective regimens. Few studies have evaluated predictors for poor treatment outcomes in children treated for TB. Methods We assessed predictors of unsuccessful TB treatment outcomes in a prospective cohort of children diagnosed by an intensified TB patient-finding intervention at four facilities in Pakistan between 2014 and 2016. A case of TB disease was determined through either bacteriologic confirmation of disease or a clinical diagnosis. To estimate characteristics predictive of experiencing an unsuccessful treatment outcome, we used a multi-level model with a modified Poisson approach, accounting for clustering at the facility level. We report estimated relative risks (RR) and 95% confidence intervals (CI). Results During the study period, 1404 children less than 15 years old were initiated on treatment for drug-susceptible TB. In total, 709 (50.5%) were 0-4, 406 (28.9%) were 5-9 years, and 289 (20.6%) were 10-14 years old; 614 (43.7%) were female; and of the 1377 children assessed for malnourishment, 1161 (84.3%) were malnourished. A total of 1322 (94.2%) children experienced a successful treatment outcome, 14 (1.0%) children transferred out to a different facility, and 68 (4.8%) children experienced an unsuccessful treatment outcome: 14 (1.0%) died, 20 (1.4%) failed treatment, and 34 (2.4%) were lost to follow-up. After adjustment for age group, sex, and malnutrition status, we identified increased risk of unsuccessful treatment outcome in children presenting with fever (RR = 2.56, 95% CI = 1.02-6.44; P = 0.05) or an abdominal examination suggestive of TB disease (RR = 2.34, 95% CI = 1.20-4.58; P = 0.01), and a decreased risk in children who initiated treatment at a rural facility (RR = 0.05, 95% CI = 0.00-0.74; P = 0.03). Conclusions More than 94% of children experienced successful treatment outcomes. We identified individual-, facility-, and clinical-factors predictive of experiencing unsuccessful treatment outcomes. Children with fevers and abdominal findings suggestive of TB disease should be tested for TB and followed closely throughout treatment to ensure necessary support for successful completion of treatment.

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“…Children with SAM typically present with malnutritionassociated immune-suppression and are more prone to severe forms of TB [3][4][5][6]. The mortality risk among patients with TB is also significantly increased with moderate or severe malnutrition [4,7,8]. Better integration of TB diagnosis into malnutrition wards is urgently needed [2,5,6,9].…”

Section: Introductionmentioning

confidence: 99%

Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children

Schramm¹,

Nganaboy²,

Uwiragiye³

et al. 2021

PLoS ONE

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Background Tuberculosis (TB) is a serious co-morbidity among children with severe acute malnutrition (SAM) and TB diagnosis remains particularly challenging in the very young. We explored whether, in a low HIV-prevalence setting, the detection of mycobacterial lipoarabinomannan (LAM) antigen in urine may assist TB diagnosis in SAM children, a pediatric population currently not included in LAM-testing recommendations. To that end, we assessed LAM test-positivity among SAM children with and without signs or symptoms of TB. Methods A cross-sectional assessment (February 2016-August 2017) included children <5 years with SAM from an Intensive-Therapeutic-Feeding-Centre in Madaoua, Niger. Group 1: children with signs or symptoms suggestive of TB. Group 2: children without any sign or symptom of TB. Urine-specimens were subjected to DetermineTM TB-LAM lateral-flow-test (using a 4-grade intensity scale for positives). LAM-results were used for study purposes and not for patient management. Programmatic TB-diagnosis was primarily based on patients’ clinical symptoms and TB contact history with no systematic access to X-ray or microbiological reference testing. Results 102 (Group 1) and 100 children (Group 2) were included (median age 18 months, 59.4% male, 1.0% HIV-positive). In Group 1, 22 (21.6%) children were started on TB-treatment (probable TB) and none of the children in Group 2. LAM-positivity was 52.0% (53/102) and 37.0% (37/100) in Group 1 and 2, respectively. Low-intensity (Grade 1) LAM test-positivity was similarly high in both Groups (37.3% and 36.0%, respectively), while Grade 2 or 3-positives were mainly detected in Group 1 (Group 1: 14.7%, Group 2: 1.0%, p<0.001). When considering only Grades >1 as positive, LAM-testing detected 22.7% (95%CI: 7.8, 45.4) among probable TB cases, while 99% (95%CI: 94.6, 99.9) of unlikely TB cases (Group 2) tested negative. Conclusion These findings suggest the potential utility of LAM urine testing in HIV-negative children with SAM. Determine LAM-positivity with Grades >1 may identify HIV-negative SAM children that are eligible for rapid TB-treatment initiation, though low-intensity (Grade 1) LAM-positive results may not be helpful in this way. Further studies in this specific pediatric population are warranted, including evaluations of new generation LAM tests.

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

Cited by 26 publications

References 18 publications

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

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

Predictors of unsuccessful tuberculosis treatment outcomes in children from a prospective cohort study in Pakistan

Potential value of urine lateral-flow lipoarabinomannan (LAM) test for diagnosing tuberculosis among severely acute malnourished children

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