Predictors of mortality among TB-HIV co-infected children attending anti-retroviral therapy clinics of selected public hospitals in southern, Ethiopia: retrospective cohort study

Abstract

Background Co-infection of tuberculosis and HIV has a significant impact on public health. TB is the most common opportunistic infection and the leading cause of death in HIV-positive children worldwide. But there is paucity of studies concerning the predictors of mortality among TB-HIV co-infected children. This study aimed to determine the predictors of mortality among TB-HIV co-infected children attending ART clinics of public hospitals in Southern Nation, Nationalities and Peoples Region (SNNPR), Ethiopia. Methods A hospital-based retrospective cohort study design was used among 284 TB-HIV co-infected children attending ART clinics at selected public hospitals in SNNPR, Ethiopia, from January 2009 to December 2019. Then, medical records of children who were TB/HIV co-infected and on ART were reviewed using a structured data extraction tool. Data were entered using Epidata 4.6 and analyzed using SPSS version 23. The Kaplan Meier survival curve along with log rank tests was used to estimate and compare survival time. Bivariable and multivariable analyses were conducted to identify predictors of mortality among TB/HIV co-infected children. Adjusted Hazard Ratio with p value < 0.05 and 95% confidence interval was considered statistically significant. Result A total of 284 TB/HIV co-infected children were included in the study. Among these, 35 (12.3%) of them died during the study period. The overall mortality rate was 2.78 (95%CI = 1.98-3.99) per 100 child years of observation. The predictors of mortality were anemia (AHR = 3.6; 95%CI: 1.39-9.31), fair or poor ART drug adherence (AHR = 2.9; 95%CI = 1.15-7.43), extrapulmonary TB (AHR = 3.9; 95%CI: 1.34-11.45) and TB drug resistance (AHR = 5.7; 95%CI: 2.07-15.96). Conclusion Mortality rate of TB/HIV co-infected children in selected public hospitals in SNNPR, Ethiopia was documented as 2.78 per child years of observation as a result of this study. Moreover, Anemia, drug resistant tuberculosis, extrapulmonary TB and poor adherence to ART drugs were identified as the predictors of mortality among these children.

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

“…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).…”

“…3, a statistically significant lower risk of death was observed in the 1-5 years age group (OR 0.40; 95% CI 0.20-0.78; P < 0.05), the 5-10 years age group (OR 0.34; 95% CI 0.16-0.72; P < 0.05), and the over 10 years age group (OR 0.35; 95% CI 0.22-0.55; P < 0.05) when compared with those under 12 months. Data from nine studies [21,24,25,27,33,36,38,43,52] reported mortality rates among children and adolescents with HIV-TB co-infection, stratified by gender. The combined mortality rates were 12% (95% CI 9-16) for males and 10% (95% CI 7-16) for females (Figure 5, Supplemental Digital Content, http://links.lww.com/ QAD/D142).…”

Active tuberculosis incidence among treatment failure experienced patients in North Wollow Zone: A multicenter historical cohort

“…By 2019, tuberculosis (TB) had surpassed HIV/AIDS as the leading cause of infectious agent-related deaths worldwide, with an estimated 10.1 million new cases and 1.7 million fatalities, marking a significant shift before 2020. 11,12 In sub-Saharan Africa, incidence rates for children and adolescents are high, with 2,017 cases per 100,000 patient-years (20). The twin epidemic of TB and HIV caused 0.3 million deaths worldwide in 2017, with a lifetime risk increase from 15% to 22% (1).…”

“…3,4 According to the WHO 2019 report, TB caused 10.1 million new cases and 1.7 million deaths, making it the leading cause of death from a single infectious agent (9). In Africa, the resurgence of TB is linked to TB-HIV/AIDS connection and a shortage of skilled healthcare personnel, not control program deterioration 5,6 In Africa, TB is the second largest disease burden (25%), following Southeast Asia (44%) (12,13). Additionally, one-third of HIV-associated deaths are attributed to TB (9,11).…”

“…Sub‐Saharan Africa alone accounted for 75% of the global HIV/AIDS prevalence. By 2019, tuberculosis (TB) had surpassed HIV/AIDS as the leading cause of infectious agent‐related deaths worldwide, with an estimated 10.1 million new cases and 1.7 million fatalities, marking a significant shift before 2020 11,12 . In sub‐Saharan Africa, incidence rates for children and adolescents are high, with 2,017 cases per 100,000 patient‐years (20).…”