Incidence and Predictors of Pulmonary Tuberculosis among Children Who Received Antiretroviral Therapy (ART), Northwest Ethiopia: A Multicenter Historical Cohorts Study 2009–2019

Abstract

The human immune deficiency virus (HIV) is the strongest risk factor for endogenous reactivation of pulmonary tuberculosis (PTB) through target reduction of CD4, T-lymphocytes, and cellular immune function. Almost one-third of deaths among people living with HIV are attributed to tuberculosis. Despite this evidence, in Ethiopia, information is scarce and meager regarding PTB incidence after ART initiated for seropositive children. Methods. Facility-based multicenter historical cohort was conducted among 721 seropositive children after initiating ART from January 1, 2009, to December 31, 2019. Data from the records of children were extracted using a standardized checklist. The collected data were entered using Epi-Data version 4.2 and exported to STATA (SE) R-14 version statistical soft wares for further analysis. Bivariable and multivariable Cox regression analyses were conducted to identify predictors of PTB incidence. Results. Seven hundred twenty-one (N = 721) seropositive children were included with a mean (±SD) age of 118.4 ± 38.24 months. During the follow-up periods, 63 (15.2%) participants developed new cases of TB; majority (61/63, 96.8%) of them were PTB. The overall incidence rate and the median (±IQR) time of PTB reported were determined as 5.86 per 100 child years (95% CI: 4.58, 7.5) and 17.8 (±11) months, respectively. At baseline, children being severely stunted (AHR = 2.9 : 95% CI, 1.2–7.8, P = 0.03 ), with Hgb ≤10 mg/dl (AHR = 4.0; 95% CI, 2.1–8.1, P = 0.001 ), and not given isoniazid and cotrimoxazole preventive therapy (AHR = 2.4; 95% CI: 1.2; 5.1, P = 0.001 ) (AHR = 2.5; 95% CI, 1.4–4.7, P = 0.021 ) were significantly associated with PTB incidence. Conclusion. A high incidence rate of PTB was observed in our study as compared with the previous finding in Ethiopia. Cases at baseline not taking IPT and CPT, being severely stunted, and having low hemoglobin (≤10 mg/dl) levels were found to be at higher risk of developing PTB.

Incidence and predictors of tuberculosis among children on antiretroviral therapy at northeast Ethiopia comprehensive specialized hospitals, 2022; A multicenter retrospective follow-up study

“…This study also revealed that being severely stunted increased the hazard of tuberculosis infection by 2.1 times compared to children who were not stunted. Similar studies have been conducted in hospitals in the northwest, Ethiopia [ 38 ], Tanzania [ 39 ], and Uganda and Zimbabwe hospitals [ 40 ]. It's possible that HIV infection causes increased nutrient malabsorption as a result of metabolic changes, resulting in weight loss and stunting over time and exposing people to opportunistic infections earlier.…”

Malaria serosurvey among acute febrile patients come for health care seeking at the high malaria-endemic setting of North West Ethiopia

“…Merkel zone is topographically located within 34° 10’N and 37° 40’E and latitude 09° 17’N and 12° 06’N and constituted by seven administrative district woreda with two primary and one-referral hospitals. 16 –22 According to the 2019 National Population Projection, this region has an estimated 1.3 million inhabitants, both urban and rural. This state has diverse topographic climates including familiar traditional zones of “kola,” “dega,” and “woman dega.” 16 –24 Pawe is one of the seven district woreda in Metekel Zone and more than 75% landmass malarious and is classified as “kola,” which is below 1500 m above sea level.…”

“…16 –22 According to the 2019 National Population Projection, this region has an estimated 1.3 million inhabitants, both urban and rural. This state has diverse topographic climates including familiar traditional zones of “kola,” “dega,” and “woman dega.” 16 –24 Pawe is one of the seven district woreda in Metekel Zone and more than 75% landmass malarious and is classified as “kola,” which is below 1500 m above sea level. This serosurvey was conducted in Pawe woreda; patients come for treatment at Felege Selam Health Center.…”

“…Merkel zone is topographically located within 34° 10'N and 37° 40'E and latitude 09° 17'N and 12° 06'N and constituted by seven administrative district woreda with two primary and one-referral hospitals. [16][17][18][19][20][21][22] According to the 2019 National Population Projection, this region has an estimated 1.3 million inhabitants, both urban and rural. This state has diverse topographic climates including familiar traditional zones of "kola," "dega," and "woman dega."…”

“…This state has diverse topographic climates including familiar traditional zones of "kola," "dega," and "woman dega." [16][17][18][19][20][21][22][23][24] Pawe is one of the seven district woreda in Metekel Zone and more than 75% landmass malarious and is classified as "kola," which is below 1500 m above sea level. This serosurvey was conducted in Pawe woreda; patients come for treatment at Felege Selam Health Center.…”