Childhood Tuberculosis in a Sub-Saharan Tertiary Facility: Epidemiology and Factors Associated with Treatment Outcome

Abstract

Childhood tuberculosis (TB) is a diagnostic challenge in developing countries, and patient outcome can be influenced by certain factors. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Kinshasa. Documentary and analytical studies were conducted using clinical and exploratory data for children aged up to 15 years who were admitted to the University Clinics of Kinshasa for TB. Data are presented as frequencies and averages, and binary and logistic regression analyses were performed. Of 283 children with TB, 82 (29.0%) had smear-negative TB, 40 (14.1%) had smear-positive TB, 159 (56.1%) had extra-pulmonary TB (EPTB), 2 (0.7%) had multidrug-resistant TB (MDR-TB), 167 (59.0%) completed treatment, 30 (10.6%) were cured, 7 (2.5%) failed treatment, 4 (1.4%) died, 55 (19.4%) were transferred to health centers nearest their home, and 20 (7.0%) were defaulters. In the binary analysis, reported TB contacts (p = 0.048), type of TB (p = 0.000), HIV status (p = 0.050), Ziehl-Nielsen test result (p = 0.000), Lowenstein culture (p = 0.004) and chest X-ray (p = 0.057) were associated with outcome. In the logistic regression, none of these factors was a significant predictor of outcome. Tertiary level care facilities must improve the diagnosis and care of patients with childhood TB, which justifies the development of alternative diagnostic techniques and the assessment of other factors that potentially affect outcome.

Childhood tuberculosis treatment outcome and its association with HIV co-infection in Ethiopia: a systematic review and meta-analysis

“…On the other hand, the finding was higher than that of a study conducted in the Democratic Republic of Congo which was 70% successful treatment outcome and of this 69.6% was treatment completed [27].…”

Trends in Tuberculosis Epidemiology among Children in the Democratic Republic of Congo

“…The distribution of smear-positive PTB cases showed an increase by age, particularly in those aged 15 -44 years (peak in 24-to 34-year-olds), corresponding to the period of increased social and sexual activity. A study previously conducted in the DRC with children from 0 to 15 years old also reported an increase in the number of cases with age[29]. This unusual distribution supports the difficulty diagnosing TB in younger children[30] [31].…”

Peer Review #2 of "Epidemiology of tuberculosis and treatment outcomes among children in Pakistan: a 5 year retrospective study (v0.2)"

“…However, the death rate in the present study was much lower than death rates (3.3-17%) previously reported elsewhere (Dangisso, Datiko & Lindtjørn, 2015;Hailu, Abegaz & Belay, 2014;Harries et al, 2002;Mtabho et al, 2010;Oeltmann et al, 2008). The default rate (4.9%) encompassed the foremost part of the unsuccessful outcome and was higher than that (0.6-3.8%) reported from other regions (Hailu, Abegaz & Belay, 2014;Satyanarayana et al, 2010;Tilahun & Gebre-Selassie, 2016) but lower (7%) than that informed by Aketi et al, 2016. In multivariate analysis, rural areas, sputum smear positivity, underweight, and retreatment were significantly associated with poor treatment outcomes. These findings are in line with previous studies (Bloss et al, 2012;Jaganath & Mupere, 2012;Sharma et al, 2008).…”

“…Manuscript to be reviewed numbers of PTB+ cases among children are reported from India and Africa (Aketi et al, 2016;Satyanarayana et al, 2010). Greater numbers of cases were diagnosed on clinical background as they were unable to expectorate and techniques like induced sputum and gastric lavage to acquire sputum among young children for smear microscopy are not frequently used at the study site.…”