Epidemiology of Pediatric Tuberculosis and Factors Associated with Unsuccessful Treatment Outcomes in the Centre Region of Cameroon: A Three-Year Retrospective Cohort Study

Abstract

Background. In Cameroon, there are limited data on treatment outcomes of pediatric tuberculosis (TB). We sought to identify the factors associated with unsuccessful treatment outcomes and the risk factors for mortality among children receiving TB treatment in the Centre Region of Cameroon. Methods. This was a multicentre facility-based retrospective cohort study using routinely collected programmatic data. All children <15 years old treated for TB between 2018 and 2020 in 21 health facilities were included. We assessed risk factors for experiencing an unsuccessful treatment outcome and mortality through multivariable logistic regression analysis. Results. Of the 610 children with TB, 307 (50.3%) were females and the median age was 6 years (IQR = 2–12). One hundred and fifty-three (25.1%) of the children were TB/HIV co-infected patients. TB treatment success (cases categorized as cured and completed treatment) was observed in 488 (80.0%) of the patients. Unsuccessful treatment outcomes were experienced by 122 (20.0%) children. Of these, 73 (12.0%) died, 4 (0.6%) had treatment failure, 25 (4.1%) were lost to follow-up, and the outcomes of 20 (3.3%) children were not evaluated. In multivariable analysis, HIV-positive status (adjusted odds ratio [AOR] = 2.43; 95% CI, 1.55–3.80, p < 0.001 ) and clinical method of TB diagnosis (AOR = 2.46; 95% CI, 1.55–3.91, p < 0.001 ] were associated with unsuccessful treatment outcomes. HIV-positive status (AOR = 4.23; 95% CI, 2.44–7.33, p < 0.001 ) and clinical method of TB diagnosis (AOR = 2.22; 95% CI, 1.25–3.91, p = 0.006 ) were the risk factors for mortality among children on TB treatment. Conclusion. The study found that HIV-TB co-infected children and those clinically diagnosed with TB were significantly more likely to have had unsuccessful TB treatment outcomes and mortality. Our findings underscore the need for healthcare workers to closely monitor and support HIV-TB co-infected children on TB treatment. TB/HIV collaborative activities should be strengthened by implementing TB preventive interventions among HIV-infected children.

Knowledge, Attitude, and Practice on Pediatric Tuberculosis Management among Healthcare Workers in the Centre Region of Cameroon: A Cross-Sectional Study

“…We applied a modified version of the multistage sampling technique to select 21 health facilities where data were collected. The 1st stage and 2nd stage of the sampling have been described in another published study [ 22 ]. Briefly, in the 1st stage, all the DTCs were stratified into public, private, and faith-based categories.…”

Mortality of children and adolescents co-infected with tuberculosis and HIV: a systematic review and meta-analysis

“…This study specifically targeted the population of children and adolescents with HIV-TB co-infection, encompassing a total of 37 studies involving 115 541 individuals. During the follow-up period, the estimated overall mortality rate for children and adolescents with HIV-TB co-infection was found to be 16% (95% CI [13][14][15][16][17][18][19][20]. Individuals solely infected with TB had a combined mortality rate of 4% (95% CI 3-7), while those solely infected with HIV was 6% (95% CI 3-13).…”

“…The duration of the follow-up period varied from 3 months to 10 years. During the follow-up period, the pooled HIV-TB co-infection mortality among children and adolescents was 16% (95% CI [13][14][15][16][17][18][19][20] with studyspecific mortality ranging from 9% to 48% (Fig. 2).…”

“…A total of seven studies [21,24,25,33,38,43,47] provided data on mortality rates among children and adolescents with HIV-TB co-infection across various age groups. The pooled mortality rates were 32% (95% CI [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] for those aged <12 months, 14% (95% CI [10][11][12][13][14][15][16][17][18][19] for the 1-5 years age group, 15% (95% CI 12-17) for the 5-10 years age group, and 16% (95% CI [13][14][15][16][17][18][19][20] for those aged over 10 years old (Figure 4, Supplemental Digital Content, http://links.lww.com/QAD/D142). As illustrated in Fig.…”

12. Các Yếu Tố Ảnh Hưởng Đến Kết Quả Điều Trị Bệnh Lao Trẻ Em Tại Khoa Nhi, Bệnh Viện Phổi Trung Ương Giai Đoạn 2017-2020

“…Việc sử dụng kết hợp nhiều loại thuốc lao cùng với thời gian dùng thuốc kéo dài đã ảnh hưởng rất nhiều đến sự tuân thủ điều trị của trẻ và gia đình. Các nghiên cứu về kết quả điều trị bệnh lao trẻ em cho thấy tỷ lệ thành công trong điều trị bệnh lao ở trẻ em là khá cao (trên 85%) [1][2][3]. Có nhiều yếu tố ảnh hưởng đến kết quả điều trị bệnh lao trẻ em như trẻ dưới 5 tuổi, chẩn đoán lao có bằng chứng vi khuẩn, tình trạng nhiễm HIV… [2,4,5].…”