Childhood tuberculosis in Mauritania, 2010–2015: diagnosis and outcomes in Nouakchott and the rest of the country

Abstract

The National Tuberculosis Programme, Mauritania. To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged<15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. This was a retrospective comparative cohort study. A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, < 0.01) while transfers out were more common in the city (25% vs. 14%, = 0.01). Being aged<5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.

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

“…Half of those unsuccessful outcomes were loss to follow-up and less than a quarter were deaths. These percentages are considerably lower than the majority of reports in the literature which, since 2016, range from 4.1% in The Netherlands [ 15 ] to 39.0% in Mauritania [ 12 ]. Two other recent reports of DS-TB treatment outcomes of children in Pakistan found that 4.9% [ 21 ] and 14.6% [ 9 ] experienced unsuccessful outcomes.…”

Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years

“…Moreover, hospital-based studies often showed a higher rate of severe TB disease [ 33 ] and thus a lower proportion of treatment success. Two kinds of databases are useful to monitor the outcomes of TB, whether success or unsuccessful treatment [ 9 , 33 , 34 ]. The MyTB version 2.1 database includes a large number of variables, such as place of treatment, BCG scars, treatment regime, directly observed therapy (DOT) for the intensive phase, and DOT supervisor.…”

Risk factors for unsuccessful tuberculosis treatment outcomes in children

“…We also found that young children less than five years of age had an increased risk of unsuccessful treatment outcomes compared to older children, which is consistent with findings from other studies. [7,9,18] TB diagnosis in young children is often delayed due to the presentation of non-specific symptoms, a need to rule out other pathogens[4], and the inability of young children to produce a sputum specimen to confirm the presence of TB disease. [5] Waiting for a clinical diagnosis may have delayed treatment initiation and, ultimately, led to disease progression to a more severe state.…”

“…Among children who are diagnosed with TB disease and initiate treatment, some groups may be at higher risk of experiencing unsuccessful treatment outcomes, including death or being lost to follow-up. Previously identified risk factors for unsuccessful treatment outcomes in children with TB include being HIV positive[7,8], being less than five years of age[7,9], having low body weight[10], and smear positivity. [11] The role of these and other risk factors may vary by setting and population.…”