The burden and outcomes of childhood tuberculosis in Cotonou, Benin

Abstract

(grouped together into the 0-14 year age group) are specifi cally identifi ed in the NTP's quarterly reports. At the General Hospital (GH) in Cotonou, the economic capital, children are diagnosed and treated on the basis of information recorded in their personal medical fi les, but are never notifi ed to the NTP, for a variety of reasons. NTP data on children are therefore incomplete and cannot be used to estimate the true burden of childhood disease in Benin.The aim of the present study was to describe the burden of TB and characteristics and outcomes along children treated in Cotonou, Benin. Specifi c objectives were to determine: 1) the total number of TB cases recorded in the NTP TB registers, and of these, the number of children aged <15 years; 2) the incidence rate of notifi ed TB cases among children aged <15 years; 3) the number of children notifi ed with TB in the NTP TB register and the number of children recorded in the GH medical fi les (who are not notifi ed in the NTP TB register) and, in each of these groups, stratifi cation by sex, age, type of TB and human immunodefi ciency virus (HIV) status; and 4) the treatment outcomes among these children stratifi ed by place of treatment, sex, age, type of TB and HIV status, from 2009 to 2011. STUDY POPULATION, DESIGN AND METHODS Study designThis was a cross-sectional, retrospective cohort study of children with TB in Cotonou based on reviews of NTP TB registers and the medical fi les of the GH. SettingBenin is a small country in West Africa with a population of 9 million and a gross national income of US$780 per capita (http://data.worldbank.org/about/countryclassifi cations). The NTP notifi es about 3500 TB cases each year. The national incidence rate of notifi ed new TB cases has been stable over the last 10 years, at 41-46 per 100 000 population. The NTP follows the DOTS strategy and uses internationally recognised criteria for diagnosing and treating patients with TB. 6,7 The NTP has a central unit responsible for policy and strategy, while diagnosis, registration and care are decentralised to 57 public or private basic management units (BMUs) in the country.The present study was conducted in Cotonou and its suburbs, which has a population of about 1 million. There are fi ve BMUs in Cotonou, all of which have a TB register and use TB treatment cards. The GH has a Interna onal Union Against Tuberculosis and Lung DiseaseHealth solu ons for the poor by the NTP and 29 (16%) by the GH; the latter were not notified to the NTP. The incidence rate of notified TB cases was between 8 and 13 per 100 000 population, and was higher in children aged >5 years. Of 167 children tested, 29% were HIV-positive. Treatment success was 72% overall, with success rates of 86%, 62% and 74%, respectively, among sputum smear-positive, sputum smear-negative and extra-pulmonary patients. Treatment success rates were lower in children with sputum smear-negative TB (62%) and those with HIV infection (58%). Conclusion:The number of children being treated for TB is low, and younger ch...

Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007–2011

“…10,11 This is in contrast to TB treatment outcomes that may be worse in children than in adults in low-income countries in sub-Saharan Africa, largely due to the additional morbidity and mortality resulting from co-infection with HIV. 12,13 The poor outcomes among adults aged 65 years in the present study are in line with the recent report from India showing poor treatment outcomes among older TB patients, particularly among those aged 70 years. 15 The high death rates among older adults observed in our study could be due in part to comorbidities such as diabetes mellitus, hypertension and associated cardiovascular diseases, (3) 5 (1) 42 (7) 22 (4) 14 (2) * Includes cured and treatment completed.…”

“…10,11 They differ, however, from patterns of disease reported from Africa, 12,13 and from those expected from the natural history of the disease, 14 where pulmonary disease is most common, particularly smear-negative PTB. This may be influenced by the effects of human immunodeficiency virus (HIV) co-infection in Africa, 12,13 but may also reflect limited access to CXR in the study setting.…”

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

“…4,5 Overall, the childhood treatment success rate was similar in Nouakchott and in the rest of Mauritania, but was lower than in adults (61% vs. 70%), and also lower than in other settings in Africa (72-85%). 12,[25][26][27] The LTFU rate of 13% was similar to that in other countries (e.g., 18% in Togo), and reflects the fragmentation of diagnosis and treatment in Mauritania.…”

“…In one study from southern Ethiopia, children with TB accounted for 13% of all TB cases, while in another, from Cotonou, Benin, they represented only 4.5%. 11,12 Recently, in Lagos, Nigeria, the proportion of children notified with TB was 6.8%, but was slowly increasing. 13 Mauritania, in West Africa, notifies about 2500 TB cases annually, with a notification rate of around 60 per 100 000 population, 2 of whom approximately 6% are children.…”

Tuberculosis in children: getting started on the road to zero [Editorial]

“…3 Another study in this issue, by Ade, compares child tuberculosis data from a general hospital with data from basic health units in Cotonou, Benin, a small West African country. 4 This study highlights issues such as underreporting of children with tuberculosis from the hospital, lack of age-disaggregated data, poor access to HIV testing in the hospital for children with tuberculosis, and lack of training in child tuberculosis for health workers, leading to missed opportunities in case detection. Similar issues are echoed in other studies, such as underreporting of childhood tuberculosis in East Java, 5 enhanced child TB case detection following private practitioner involvement in Karachi 6 and following health worker training in Bangladesh.…”