Prevalence, radio-clinical patterns and factors associated with pulmonary tuberculosis among children with severe acute malnutrition: A crossectional study in Uganda

Abstract

Background Although treatable, pulmonary tuberculosis (PTB) has a significant morbidity and mortality. Children with malnutrition are immune compromised, which increases the morbidity and mortality of PTB. This study was done to determine the prevalence and factors associated with Tuberculosis among children aged 6 to 59 months admitted with severe acute malnutrition (SAM) at Jinja Regional Referral Hospital (JRRH). Methods This was a cross–sectional study among children aged 6-59 months with SAM at JRRH. History was taken and physical examination done. Gene Xpert was done for all participants, Lipoarabinomannan Antigen Assay for TB (TB-LAM) done for HIV positive children with CD4 below 200 and Chest X-ray for children who presented with cough and difficulty in breathing. Both the investigations and clinical findings were used to make a diagnosis of PTB. Using binary logistic regression in SPSS, the factors associated with Tuberculosis were determined. P value <0.05 was considered significant. Results Of the 137 children enrolled with SAM, majority were in the age groups of 6-11 and 12-23 months. Non-edematous malnutrition was the commonest 73(53.3%). Thirty-two children were diagnosed with TB with a prevalence of 23.4%. Of the 32 diagnosed with Tuberculosis, only 5 had a positive gene expert test, 2 had a positive urine TB LAM and the remaining 25 were diagnosed using the clinical criteria. The commonest symptoms among children diagnosed with TB were cough seen in 25/32 (78.1%) and fever in 24/32 (75%). The most common radiological findings comprised adenopathy (64.3%) and consolidations (49.7%). Coming from rural areas (aOR=1.205, 95%CI=1.067-1.360, P=0.003), being HIV positive (aOR=1.619, CI=1.114-2.354, P=0.012), thrombocytopenia (aOR=1.407, CI=1.069-1.853, P=0.015) and thrombocytosis (aOR=1.202, CI=1.047-1.379, P=0.009) were independently associated with presence of Tuberculosis. Conclusion The prevalence of tuberculosis in Severe Acute Malnutrition was high. Children with SAM should be routinely screened for TB. When resources are constrained, the iinvestigations for TB could be focused on those coming from rural areas, the HIV positive, those with thrombocytopenia and those with thrombocytosis.