Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia

• Published in: The international journal of tuberculosis and lung disease Vol. 17; no. 12; pp. 1518 - 1523
• Main Authors: Russell, G. K., Merle, C. S., Cooke, G. S., Casas, E. C., Silveira da Fonseca, M., du Cros, P.
• Format: Journal Article
• Language: English
• Published: Paris, France International Union Against Tuberculosis and Lung Disease 01.12.2013; International Union against Tuberculosis and Lung Disease
• Subjects: Adolescent; Africa; Age Factors; Antitubercular Agents - therapeutic use; Asia - epidemiology; Bacterial diseases; Biological and medical sciences; Child; Child Mortality; Child, Preschool; Co-Infection; Coinfection; Female; HIV; HIV Infections - diagnosis; HIV Infections - mortality; Human bacterial diseases; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infant; Infant Mortality; Infant, Newborn; Infectious diseases; International Agencies; Logistic Models; Male; Medical sciences; Multivariate Analysis; Mycobacterium; Odds Ratio; Paediatric; Pneumology; Predictive Value of Tests; Program Evaluation; Retrospective Studies; Risk Factors; Sub-Saharan Africa; Treatment Outcome; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - mortality; Tuberculosis and atypical mycobacterial infections; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; World Health Organization; Asia; Sub-Saharan Africa; Africa; Pediatrics; Mixed infection; Prognosis; Mycobacterial infection; Epidemiology; paediatric; Target; sub-Saharan Africa; Child; WHO; Human; Immunopathology; co-infection; Respiratory disease; Mortality; Retroviridae; AIDS; Immune deficiency; Lentivirus; Infection; Virus; Tuberculosis; HIV; Viral disease; Bacteriosis; Death; Human immunodeficiency virus
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.13.0238

SETTING: Achieving the World Health Organization (WHO) target of zero paediatric tuberculosis (TB) deaths will require an understanding of the underlying risk factors for mortality.OBJECTIVE: To identify risk factors for mortality and assess the impact of human immunodeficiency virus (HIV) testing during anti-tuberculosis treatment in children in 13 TB-HIV programmes run by Médecins Sans Frontières.DESIGN: In a retrospective cohort study, we recorded mortality and analysed risk factors using descriptive statistics and logistic regression. Diagnosis was based on WHO algorithm and smear microscopy.RESULTS: A total of 2451 children (mean age 5.2 years, SD 3.9) were treated for TB. Half (51.0%) lived in Asia, the remainder in sub-Saharan Africa; 56.0% had pulmonary TB; 6.4% were diagnosed using smear microscopy; 211 (8.6%) died. Of 1513 children tested for HIV, 935 (61.8%) were positive; 120 (12.8%) died compared with 30/578 (5.2%) HIV-negative children. Risk factors included being HIV-positive (OR 2.6, 95%CI 1.6-4.2), age <5 years (1.7, 95%CI 1.2-2.5) and having tuberculous meningitis (2.6, 95%CI 1.0-6.8). Risk was higher in African children of unknown HIV status than in those who were confirmed HIV-negative (1.9, 95%CI 1.1-3.3).CONCLUSIONS: Strategies to eliminate childhood TB deaths should include addressing the high-risk groups identified in this study, enhanced TB prevention, universal HIV testing and the development of a rapid diagnostic test.