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Tuberculosis in HIV-infected Tanzanian children below 14 years
1Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Insights
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection affects one-fifth of children. Male gender, young age, and severe immunosuppression are risk factors for TB in HIV-infected children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection presents a significant global health challenge.
- Diagnosing TB in children is complex due to non-specific clinical signs, difficult-to-interpret chest radiographs, and unhelpful routine laboratory tests.
- Current diagnostic approaches often rely on identifying an adult TB case within the household.
Purpose of the Study:
- To determine the prevalence of TB among HIV-infected children under 14 years old.
- To identify risk factors associated with TB in this pediatric population.
- To assess the utility of clinical manifestations and CD4+ T-lymphocyte counts in predicting active TB.
Main Methods:
- A cross-sectional study was conducted involving 182 HIV-infected children under 14 years at Muhimbili National Hospital, Tanzania.
- Data collection included socio-demographic information, clinical assessment, tuberculin skin testing, chest radiography, sputum microscopy and culture, and CD4+ T-lymphocyte percentage.
- Statistical analysis utilized Chi-square tests and odds ratios to identify significant risk factors and associations.
Main Results:
- The overall prevalence of TB among HIV-infected children was 20.3% (37 out of 182).
- TB prevalence was significantly higher in males (78.4%) and in children under 24 months (45.9%).
- Male gender, history of TB contact, and severe immunosuppression were identified as significant risk factors, while antiretroviral therapy use was associated with a decreased risk.
Conclusions:
- Approximately one-fifth of HIV-infected children in the study had TB co-infection.
- A low CD4+ T-lymphocyte percentage and the presence of four or more clinical manifestations can aid in predicting active TB in HIV-infected children.
- Early identification and management of TB in this vulnerable population are crucial public health priorities.
Objective:
Tuberculosis (TB)-human immunodeficiency virus (HIV) co-infection is an important public health problem. Diagnosis of TB in children usually follows discovery of an adult case, and relies on clinical presentation, sputum examination and chest radiograph. However, clinical features are non-specific, chest radiographs are difficult to interpret, and routine laboratory tests are not helpful. The aim of the current study was to determine the prevalence of TB in HIV-infected children below 14 years attending a tertiary hospital.
Methods:
A cross-sectional study was conducted in HIV-infected children below 14 years of age at Muhimbili National Hospital, in Dar es Salaam, Tanzania, between July 2008 and January 2009. Information on socio-demographic and anthropometric characteristics was collected using a structured questionnaire. Following assessment of clinical presentation, physical examination, tuberculin skin test, and chest radiograph were performed for each child. Two consecutive sputum specimens and blopd sample were collected for microscopy and culture, and CD4 T-lymphocyte percentage test, respectively. Chi-square test was used to compare differences in proportions. Odds ratio (OR) and their 95% confidence interval (CI) are presented as the risk estimator.
Results:
Of 182 HIV-infected children enrolled in the study, 104 (57.1%) were males. Overall, thirty-seven (20.3%) children had TB. The prevalence of TB was highest in males (78.4%) compared to females (p = 0.003). There was a higher proportion of TB (45.9%) in the age group below 24 months compared to other age groups (p = 0.001). Male gender, history of positive TB contact and severe immunosuppression were found to be significant risk factors for TB while use of antiretroviral therapy was found to be associated with decreased risk for TB.
Conclusions:
One-fifth of children had TB/HIV co-infection. Presence of four or more clinical manifestations and a low CD4+ T-lymphocyte percentage can be used to predict active TB in HIV-infected children.
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