Factors Affecting Outcome of Tuberculosis in Children in Italy: An Ecological Study

Area of Science:

• Pediatric Infectious Diseases
• Public Health
• Epidemiology

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly affecting children.
• In low-incidence countries, TB is re-emerging, with foreign-born individuals constituting a substantial proportion of cases.
• Family socioeconomic factors play a crucial role in the management and outcomes of pediatric TB.

Purpose of the Study:

• To investigate the impact of family socioeconomic features on the management and outcomes of children with tuberculosis.
• To compare disease complexity, drug resistance, and healthcare access between children of Italian and foreign origin.

Main Methods:

• A retrospective study was conducted at a tertiary care center for pediatric infectious diseases in Italy.
• Data were collected on 49 Italian children and 30 children of foreign origin diagnosed with TB.
• Statistical analyses were performed to compare disease characteristics, treatment outcomes, and healthcare utilization.

Main Results:

• Children from foreign families presented with more complicated TB disease (20% vs 0%, P=0.002) and higher rates of drug-resistant strains (20% vs 2%, P=0.011).
• Foreign-origin children experienced longer hospital stays (12 vs 5.1 days, P=0.012) and missed more medical appointments (15.7% vs 8.6%, P≤0.042).
• Drug-resistant strains were an independent risk factor for complicated TB (OR: 72.98), with higher risk in children from Eastern Europe (OR: 10.16).

Conclusions:

• Immigrant children with TB face increased risks of complicated disease courses, largely due to higher prevalence of resistant strains.
• Management challenges include higher rates of drug resistance and difficulties in healthcare access and adherence.
• Development of specific healthcare protocols is essential to support immigrant pediatric populations, ensuring equitable access to health services and consistent monitoring.