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Childhood tuberculosis in Malawi: nationwide case-finding and treatment outcomes
A D Harries1, N J Hargreaves, S M Graham
1National Tuberculosis Control Programme, Community Health Science Unit, Lilongwe, Malawi. adharries@malawi.net
Insights
Childhood tuberculosis (TB) is prevalent in Malawi, with over 11% of cases affecting children. Treatment outcomes are poor, highlighting the need for improved diagnosis and management strategies.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in low-income countries.
- Childhood TB presents unique diagnostic and management difficulties.
- Understanding the epidemiology and treatment outcomes of childhood TB is crucial for effective control programs.
Purpose of the Study:
- To determine the incidence, characteristics, and treatment success rates of childhood TB in Malawi.
- To identify factors influencing treatment outcomes in pediatric TB patients.
- To inform public health strategies for combating childhood TB.
Main Methods:
- Retrospective analysis of data from TB registers and patient records across 43 non-private hospitals in Malawi.
- Inclusion of all adult and pediatric TB cases registered in 1998.
- Standardized definitions were used to collect information on case numbers, TB types, and treatment outcomes.
Main Results:
- In 1998, children constituted 11.9% (2,739) of the 22,982 registered TB cases in Malawi.
- Children represented 1.3% of smear-positive pulmonary TB, 21.3% of smear-negative pulmonary TB, and 15.9% of extra-pulmonary TB notifications.
- Treatment completion was only 45%, with high rates of death (17%), default (13%), and unknown outcomes (21%); outcomes were worse in younger children and those with smear-negative TB.
Conclusions:
- Childhood tuberculosis is a substantial public health issue in Malawi, characterized by unfavorable treatment outcomes.
- There is an urgent need for enhanced diagnostic approaches and follow-up care for pediatric TB patients.
- The National TB Programme should prioritize the management of contacts of smear-positive TB cases to prevent childhood TB transmission.
Setting:
All 43 non-private hospitals (three central, 22 [corrected] district and 18 [corrected] mission) in Malawi that register and treat adult and paediatric TB cases.
Objective:
To assess the rate, pattern and treatment outcome of childhood TB case notifications in Malawi in 1998.
Design:
Retrospective data collection using TB registers, treatment cards and information from health centre registers. Information was collected on number of cases, types of TB and treatment outcomes using standardised definitions.
Results:
There were 22,982 cases of TB registered in Malawi in 1998, of whom 2,739 (11.9%) were children. Children accounted for 1.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extra-pulmonary TB (EPTB). Estimated rates of TB in children were 78/ 100,000 in those aged less than one year, 83/100,000 in those aged 1-4 years and 33/100,000 in those aged 5-14 years. A significantly higher proportion of TB cases was diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. Treatment completion was best (76%) and death rates lowest (11%) for the 127 children with smear-positive PTB.
Conclusion:
Childhood TB is common in Malawi and treatment outcomes are poor. Research should be directed towards improved diagnosis and follow-up of children with TB, and the National TB Programme should support appropriate management of childhood contacts of smear positive PTB cases.