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Published in: BMC Pediatrics 1/2014

Open Access 01-12-2014 | Research article

Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study

Published in: BMC Pediatrics | Issue 1/2014

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Abstract

Background

Tuberculosis (TB) remains a significant public health problem leading to high morbidity and mortality both in adults and children. Reports on childhood TB and its treatment outcome are limited. In this retrospective study, we analyzed the epidemiology and treatment outcomes of TB among children in Addis Ababa.

Methods

Children registered for TB treatment over 5 years (2007 to 2011) were included in the analysis. Demographic and clinical data including treatment outcomes were extracted from TB unit registers of 23 health centers in Addis Ababa. Multivariate logistic regression was used to identify predictors of poor treatment outcomes.

Results

Among 41,254 TB patients registered for treatment at the 23 health centers, 2708 (6.6%) were children. Among children with TB, the proportions of smear positive PTB, smear negative PTB and EPTB were 9.6%, 43.0% and 47.4%, respectively. Treatment outcomes were documented for 95.2% of children of whom 85.5% were successfully treated while rates of mortality and defaulting from treatment were 3.3% and 3.8%, respectively. The proportion of children with TB tested for HIV reached 88.3% during the final year of the study period compared to only 3.9% at the beginning of the study period. Mortality was significantly higher among under-five children (p < 0.001) and those with HIV co-infection (p < 0.001). On multivariate logistic regression, children 5–9 years [AOR = 2.50 (95% CI 1.67-3.74)] and 10–14 years [AOR = 2.70 (95% CI 1.86-3.91)] had a significantly higher successful treatment outcomes. On the other hand, smear positive PTB [AOR = 0.44 (95% CI 0.27-0.73), HIV co-infection (AOR = 0.49(95% CI 0.30-0.80)] and unknown HIV sero-status [AOR = 0.60 (95% CI 0.42-0.86)] were predictors of poor treatment outcomes.

Conclusion

The proportion of childhood TB in this study is lower than the national estimate. The overall treatment success rate has met the WHO target. Nonetheless, younger children (< 5 years), children with smear positive PTB and those with HIV co-infection need special attention to reduce poor treatment outcomes among children in the study area.
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Literature
1.
go back to reference World Health Organization: Global tuberculosis report. 2013, Geneva World Health Organization: Global tuberculosis report. 2013, Geneva
2.
go back to reference Swaminathan S, Rekha B: Pediatric tuberculosis: global overview and challenges. Clin Infect Dis. 2010, 50 (S3): S184-S194. 10.1086/651490.CrossRefPubMed Swaminathan S, Rekha B: Pediatric tuberculosis: global overview and challenges. Clin Infect Dis. 2010, 50 (S3): S184-S194. 10.1086/651490.CrossRefPubMed
3.
go back to reference Nelson LJ, Wells CD: Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis. 2004, 8 (5): 636-647.PubMed Nelson LJ, Wells CD: Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis. 2004, 8 (5): 636-647.PubMed
4.
go back to reference World Health Organization: Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2006, Geneva World Health Organization: Guidance for national tuberculosis programmes on the management of tuberculosis in children. 2006, Geneva
5.
go back to reference Federal Ministry of Health: Guidelines for clinical and programmatic management of TB, TB/HIV and Leprosy in Ethiopia. 2012, Addis Ababa Federal Ministry of Health: Guidelines for clinical and programmatic management of TB, TB/HIV and Leprosy in Ethiopia. 2012, Addis Ababa
6.
go back to reference Tsai K, Chang H, Chien S, Chen K, Chen K, Mai M, Chen K: Childhood Tuberculosis: Epidemiology, Diagnosis, Treatment, and Vaccination. Pediatr Neonatol. 2013, 54 (5): 295-302. 10.1016/j.pedneo.2013.01.019.CrossRefPubMed Tsai K, Chang H, Chien S, Chen K, Chen K, Mai M, Chen K: Childhood Tuberculosis: Epidemiology, Diagnosis, Treatment, and Vaccination. Pediatr Neonatol. 2013, 54 (5): 295-302. 10.1016/j.pedneo.2013.01.019.CrossRefPubMed
7.
go back to reference Chintu C, Mudenda V, Lucas S, Nunn A, Lishimpi K, Maswahu D, Kasolo F, Mwaba P, Bhat G, Terunuma H, Zumla A, for the UNZA-UCLMS Project Paediatric Post-mortem Study Group: Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet. 2002, 360: 985-90. 10.1016/S0140-6736(02)11082-8.CrossRefPubMed Chintu C, Mudenda V, Lucas S, Nunn A, Lishimpi K, Maswahu D, Kasolo F, Mwaba P, Bhat G, Terunuma H, Zumla A, for the UNZA-UCLMS Project Paediatric Post-mortem Study Group: Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet. 2002, 360: 985-90. 10.1016/S0140-6736(02)11082-8.CrossRefPubMed
8.
go back to reference Munˇ oz-sellart M, Yassin MA, Tumato M, Merid Y, Cuevas LE: Treatment outcome in children with tuberculosis in Southern Ethiopia. Scand J Infect Dis. 2009, 41: 450-455. 10.1080/00365540902865736.CrossRef Munˇ oz-sellart M, Yassin MA, Tumato M, Merid Y, Cuevas LE: Treatment outcome in children with tuberculosis in Southern Ethiopia. Scand J Infect Dis. 2009, 41: 450-455. 10.1080/00365540902865736.CrossRef
9.
go back to reference Ramos JM, Reyes F, Tesfamariam A: Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: a ten-year retrospective study. BMC Public Health. 2010, 10: 215-10.1186/1471-2458-10-215.CrossRefPubMedPubMedCentral Ramos JM, Reyes F, Tesfamariam A: Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: a ten-year retrospective study. BMC Public Health. 2010, 10: 215-10.1186/1471-2458-10-215.CrossRefPubMedPubMedCentral
10.
go back to reference Population Census Commission: Summary and statistical report of the 2007 Population and Housing Census results. 2008, Addis Ababa Population Census Commission: Summary and statistical report of the 2007 Population and Housing Census results. 2008, Addis Ababa
11.
go back to reference Federal Ministry of Health: Tuberculosis, Leprosy and TB/HIV prevention and control program: Annual Bulletin Number 4. 2012, Addis Ababa Federal Ministry of Health: Tuberculosis, Leprosy and TB/HIV prevention and control program: Annual Bulletin Number 4. 2012, Addis Ababa
12.
go back to reference Getahun B, Ameni G, Biadgilign S, Medhin G: Mortality and associated risk factors in a cohort of tuberculosis patients treated under DOTS programme in Addis Ababa. Ethiopia. BMC Infect Dis. 2011, 11: 127-10.1186/1471-2334-11-127.CrossRefPubMed Getahun B, Ameni G, Biadgilign S, Medhin G: Mortality and associated risk factors in a cohort of tuberculosis patients treated under DOTS programme in Addis Ababa. Ethiopia. BMC Infect Dis. 2011, 11: 127-10.1186/1471-2334-11-127.CrossRefPubMed
13.
go back to reference Yimer S, Bjune G, Alene G: Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005, 5: 112-10.1186/1471-2334-5-112.CrossRefPubMedPubMedCentral Yimer S, Bjune G, Alene G: Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC Infect Dis. 2005, 5: 112-10.1186/1471-2334-5-112.CrossRefPubMedPubMedCentral
14.
go back to reference Belay M, Bjune G, Ameni G, Abebe F: Diagnostic and treatment delay among tuberculosis patients in afar region, Ethiopia: across-sectional study. BMC Public Health. 2012, 12: 369-10.1186/1471-2458-12-369.CrossRefPubMedPubMedCentral Belay M, Bjune G, Ameni G, Abebe F: Diagnostic and treatment delay among tuberculosis patients in afar region, Ethiopia: across-sectional study. BMC Public Health. 2012, 12: 369-10.1186/1471-2458-12-369.CrossRefPubMedPubMedCentral
15.
go back to reference Demissie M, Lindtjorn B, Berhane Y: Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2002, 2: 23-10.1186/1471-2458-2-23.CrossRefPubMedPubMedCentral Demissie M, Lindtjorn B, Berhane Y: Patient and health service delay in the diagnosis of pulmonary tuberculosis in Ethiopia. BMC Public Health. 2002, 2: 23-10.1186/1471-2458-2-23.CrossRefPubMedPubMedCentral
16.
go back to reference Marais BJ, Obihara CC, Warren RM, Schaaf HS, Gie RP, Donald PR: The burden of childhood tuberculosis:a public health perspective. Int J Tuberc Lung Dis. 2005, 9 (12): 1305-1313.PubMed Marais BJ, Obihara CC, Warren RM, Schaaf HS, Gie RP, Donald PR: The burden of childhood tuberculosis:a public health perspective. Int J Tuberc Lung Dis. 2005, 9 (12): 1305-1313.PubMed
17.
go back to reference Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B, MRCP: Paediatric tuberculosis. Lancet Infect Dis. 2008, 8 (8): 498-510. 10.1016/S1473-3099(08)70182-8.CrossRefPubMed Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B, MRCP: Paediatric tuberculosis. Lancet Infect Dis. 2008, 8 (8): 498-510. 10.1016/S1473-3099(08)70182-8.CrossRefPubMed
18.
go back to reference Harries AD, Hargreaves NJ, Graham SM, Mwansambo C, Kazembe P, Broadhead RL, Maher D, Salaniponi FM: Childhood tuberculosis in Malawi: Nationwide case-finding and treatment outcomes. Int J Tuberc Lung Dis. 2002, 6 (5): 424-431.PubMed Harries AD, Hargreaves NJ, Graham SM, Mwansambo C, Kazembe P, Broadhead RL, Maher D, Salaniponi FM: Childhood tuberculosis in Malawi: Nationwide case-finding and treatment outcomes. Int J Tuberc Lung Dis. 2002, 6 (5): 424-431.PubMed
19.
go back to reference Mtabho CM, Irongo CF, Boeree MJ, Aarnoutse RE, Kibiki GS: Childhood Tuberculosis in the Kilimanjaro region: lessons from and for the TB Programme. Trop Med Int Health. 2010, 15 (5): 496-501.PubMed Mtabho CM, Irongo CF, Boeree MJ, Aarnoutse RE, Kibiki GS: Childhood Tuberculosis in the Kilimanjaro region: lessons from and for the TB Programme. Trop Med Int Health. 2010, 15 (5): 496-501.PubMed
20.
go back to reference Lolekha R, Anuwatnonthakate A, Nateniyom S, Sumnapun S, Yamada N, Wattanaamornkiat W, Sattayawuthipong W, Charusuntonsri P, Sanguanwongse N, Wells CD, Varma JK: Childhood TB epidemiology and treatment outcomes in Thailand: a TB active surveillance network, 2004 to 2006. BMC Infect Dis. 2008, 8: 94-10.1186/1471-2334-8-94.CrossRefPubMedPubMedCentral Lolekha R, Anuwatnonthakate A, Nateniyom S, Sumnapun S, Yamada N, Wattanaamornkiat W, Sattayawuthipong W, Charusuntonsri P, Sanguanwongse N, Wells CD, Varma JK: Childhood TB epidemiology and treatment outcomes in Thailand: a TB active surveillance network, 2004 to 2006. BMC Infect Dis. 2008, 8: 94-10.1186/1471-2334-8-94.CrossRefPubMedPubMedCentral
21.
go back to reference Mukadi YD, Wiktor SZ, Coulibaly I, Coulibaly D, Mbengue A, Folquet AM, Ackah A, Sassan-Morokro M, Bonnard D, Maurice C, Nolan C, Kreiss JK, Greenberg AE: Impact of HIV infection on the development, clinical presentation, and outcome of tuberculosis among children in Abidjan, Côte d’Ivoire. AIDS. 1997, 11: 1151-1158. 10.1097/00002030-199709000-00011.CrossRefPubMed Mukadi YD, Wiktor SZ, Coulibaly I, Coulibaly D, Mbengue A, Folquet AM, Ackah A, Sassan-Morokro M, Bonnard D, Maurice C, Nolan C, Kreiss JK, Greenberg AE: Impact of HIV infection on the development, clinical presentation, and outcome of tuberculosis among children in Abidjan, Côte d’Ivoire. AIDS. 1997, 11: 1151-1158. 10.1097/00002030-199709000-00011.CrossRefPubMed
22.
go back to reference Oeltmann JE, Chengeta B, Mboya JJ, Wells CD, Kilmarx PH, Samandari T, Nelson LJ: Reported childhood tuberculosis treatment outcomes, Gaborone and Francistown, Botswana, 1998–2002. Int J Tuberc Lung Dis. 2008, 12 (2): 186-192.PubMed Oeltmann JE, Chengeta B, Mboya JJ, Wells CD, Kilmarx PH, Samandari T, Nelson LJ: Reported childhood tuberculosis treatment outcomes, Gaborone and Francistown, Botswana, 1998–2002. Int J Tuberc Lung Dis. 2008, 12 (2): 186-192.PubMed
23.
go back to reference Bloss E, Chan PC, Cheng NW, Wang KF, Yang SL, Cegielski P: Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan. Int J Tuberc Lung Dis. 2012, 16 (4): 462-467. 10.5588/ijtld.11.0121.CrossRefPubMed Bloss E, Chan PC, Cheng NW, Wang KF, Yang SL, Cegielski P: Increasing directly observed therapy related to improved tuberculosis treatment outcomes in Taiwan. Int J Tuberc Lung Dis. 2012, 16 (4): 462-467. 10.5588/ijtld.11.0121.CrossRefPubMed
24.
go back to reference Enarson PM, Enarson DA, Gie R: Management of tuberculosis in children in low-income countries. Int J tuberc Lung Dis. 2005, 9 (12): 1299-PubMed Enarson PM, Enarson DA, Gie R: Management of tuberculosis in children in low-income countries. Int J tuberc Lung Dis. 2005, 9 (12): 1299-PubMed
25.
go back to reference Tweya H, Feldacker C, Phiri S, Ben-Smith A, Fenner L, Jahn A, Kalulu M, Weigel R, Kamba C, Banda R, Egger M, Keiser O: Comparison of treatment outcomes of New smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, malawi. PLoS ONE. 2013, 8 (2): e56248-10.1371/journal.pone.0056248.CrossRefPubMedPubMedCentral Tweya H, Feldacker C, Phiri S, Ben-Smith A, Fenner L, Jahn A, Kalulu M, Weigel R, Kamba C, Banda R, Egger M, Keiser O: Comparison of treatment outcomes of New smear-positive pulmonary tuberculosis patients by HIV and antiretroviral status in a TB/HIV clinic, malawi. PLoS ONE. 2013, 8 (2): e56248-10.1371/journal.pone.0056248.CrossRefPubMedPubMedCentral
Metadata
Title
Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study
Publication date
01-12-2014
Published in
BMC Pediatrics / Issue 1/2014
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/1471-2431-14-61

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Reviewer acknowledgement

Reviewer acknowledgement 2013