Risk factors for unsuccessful tuberculosis treatment outcomes in children

• Published in: PloS one Vol. 14; no. 9; p. e0222776
• Main Authors: Hamid, Meherunissa, Brooks, Meredith B., Madhani, Falak, Ali, Hassan, Naseer, Mohammad Junaid, Becerra, Mercedes, Amanullah, Farhana
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.09.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Age Factors; Antitubercular Agents - pharmacology; Antitubercular Agents - therapeutic use; Biology and Life Sciences; Child; Child, Preschool; Children; Clinical outcomes; Drug development; Epidemiology; Family medical history; Female; Health aspects; Health care networks; Health risks; Humans; Infant; Infant, Newborn; Logistic Models; Male; Males; Medical diagnosis; Medical research; Medicine and Health Sciences; Microbial Sensitivity Tests; Multivariate analysis; Mycobacterium tuberculosis - drug effects; Mycobacterium tuberculosis - isolation & purification; Pakistan; Patient outcomes; Pediatrics; People and Places; Public health; Regression analysis; Retrospective Studies; Risk analysis; Risk assessment; Risk Factors; Treatment Failure; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - microbiology; Pakistan; Malawi; United States > US; Karachi Pakistan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222776

Pakistan has a high pediatric burden of tuberculosis, but few studies describe the treatment experience of children with tuberculosis in Pakistan. We sought to identify risk factors for unsuccessful treatment outcomes in children with drug-susceptible tuberculosis identified in eight hospitals in Karachi, Pakistan. We conducted a retrospective cohort study among children (<15 years old) treated with first-line anti-tuberculosis drugs for presumed or confirmed drug-susceptible tuberculosis between 2016 and 2017. We assessed risk factors for experiencing an unsuccessful treatment outcome through multivariable logistic regression analysis. In total, 1,665 children initiated tuberculosis treatment, including 916 (55.0%) identified through intensified case finding. Unsuccessful treatment outcomes were experienced by 197 (11.8%) children, comprising 27 (1.6%) deaths, 16 (1.0%) treatment failures, and 154 (9.3%) lost to follow-up. An additional 47 (2.8%) children had outcomes not evaluable. In multivariable analysis, children 0-4 years old (OR: 1.80, 95% CI: 1.07-3.04), males (OR: 1.48, 95% CI: 1.04, 2.11), and those with bacteriologic confirmation of disease (OR: 3.39, 95% CI: 1.98, 5.80) had increased odds of experiencing an unsuccessful treatment outcome. Our findings suggest a need to deploy strategies to identify children earlier in the disease process and point to the need for interventions tailored for young children once treatment is initiated.