Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern  Uganda, 2013-2017

Abstract

Background: Childhood tuberculosis (TB) remains a major public health problem in Uganda. Failure to complete TB treatment is associated with development of multi-drug-resistant TB, continued spread of TB, and death. The World Health Organization (WHO) recommends treatment success rates of ≥85% to achieve TB control, but children often have lower success rates due to challenges in case identification and treatment adherence. We assessed trends in childhood TB case notification rates, spatial case distribution, treatment outcomes, and predictors of treatment completion at Mbale Regional Referral Hospital (MRRH) in Eastern Uganda.Methods: We reviewed TB registers and extracted data for patients aged 0-14 years with presumptive TB at MRRH for 2013-2017. We determined the childhood TB case notification rate in the MRRH catchment area, performed a TB case notification rate trend analysis and described spatial TB case distribution. We used logistic regression to identify patient-related and hospital-related factors associated with completion of TB treatment at MRRH among HIV-positive and HIV-negative patients. Results: We identified 331 TB case notifications among children <15 years. TB case notification rates declined from 6.6/100,000 in 2013 to 2.2/100,000 in 2017 [odds ratio (OR)=0.81; 95% confidence intervals (CI)=0.58-1.1]. Mbale District recorded the highest TB case notification rate (79/100,000), and Kapchorwa District recorded the lowest TB case notification rate (3.8/100,000). Completion rates varied from 35% to 80%. Of the 331 patients, 167 (50%) completed TB treatment. In logistic regression, 142 (75%) of 189 HIV-negative TB patients completed TB treatment compared to 25 (54%) of 46 HIV-positive TB patients (OR=2.5; 95%CI=1.3-4.9). Seventy-four (63%) of 117 patients in the facility-based model and 93 (79%) of patients in the community-based model completed TB treatment (OR=0.47; 95% CI=0.26-0.83).Conclusions: Only half of childhood TB patients completed treatment, well below the WHO target of ≥85% completion. Although TB completion was associated with treatment model and HIV-negative status, neither HIV-positive nor HIV-negative patients had acceptable completion rates. MRRH should strengthen HIV treatment services among childhood TB patients by engaging peer groups and trusted community leaders to provide education on the importance of completing TB treatment.

Notes from the field: Descriptive Exploration of childhood tuberculosis frequency and risk factors of zoonotic bovine tuberculosis in Moroto district, Uganda

“…Childhood tuberculosis represented 352 (47%) of all registered cases in Moroto district. Similar high case numbers were reported by (5,20) in Mbarara and Mbale districts respectively, however (6) reported a lower TB frequency of 7.5% in Kampala. Other developing countries such as Pakistan reported high case numbers at 42.4% while Kenya reported low frequency at 9% ( 21).…”

“…This could explain why the completion rates are below 100%. Previous studies in Uganda by (20,25) reported lower completion rates in rural areas at 29% for Butaleja and 48% for Mbale respectively. This increase in completion rate should be attributed to current efforts by Ministry of Health of Uganda and her partners that has put deliberate efforts in improving the coverage treatment coverage in Teso and Karamoja region (Nidoi et al, 2021).…”

“…88,000 TB cases were con rmed of which 13 % were children below 15 years and 15,600 cases died (1). Several studies show that child hood TB cases might be under-reported and could be as high as 20 % of TB cases in Uganda (4)(5)(6)(7). Diagnosis of TB in children is di cult since the disease often mimics many other common childhood diseases like pneumonia (7).…”