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Published on: August 16, 2021
Initiation of anti-tuberculosis treatment in children following gastric aspirate testing, Botswana, 2008-2012
T Q Lo1, L Matlhare2, K Mugisha3
1Epidemic Intelligence Service, Division of Global Health Protection, Division of TB Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA.
Insights
Diagnosing pediatric tuberculosis (TB) is challenging. Gastric aspiration (GA) improved diagnosis, but treatment initiation documentation for confirmed cases needs urgent attention.
Area of Science:
- Pediatric infectious diseases
- Global health
- Diagnostic microbiology
Background:
- Pediatric tuberculosis (TB) diagnosis presents significant challenges.
- Gastric aspiration (GA) is a diagnostic tool used in resource-limited settings.
- Improving treatment initiation and outcomes for children with TB is a public health priority.
Purpose of the Study:
- To evaluate the effectiveness of gastric aspiration (GA) in diagnosing pediatric tuberculosis (TB).
- To describe treatment initiation and outcomes for children diagnosed with TB via GA or treated empirically.
- To identify gaps in TB treatment documentation and initiation for children.
Main Methods:
- Gastric aspiration (GA) was performed in 1268 children across 121 health facilities in Botswana.
- Treatment initiation and outcomes were tracked using electronic TB registries and name-based matching.
- Descriptive statistics and regression models were employed for data analysis.
Main Results:
- Out of 1268 children, 121 (9.5%) had positive GA results, with 90 (74.3%) initiating TB treatment.
- An additional 137 children (11.9%) received empirical TB treatment.
- Human immunodeficiency virus (HIV) status was significantly associated with TB treatment initiation (aOR 1.8).
- Nearly all children with positive GA results either completed treatment or were still undergoing treatment.
Conclusions:
- A significant gap exists in documenting treatment for over a quarter of children with laboratory-confirmed TB.
- The failure to initiate prompt treatment for pediatric TB requires urgent investigation and intervention.
- Gastric aspiration (GA) shows promise in diagnosing pediatric TB, but systemic issues in treatment follow-up persist.
Setting:
Diagnosing pediatric tuberculosis (TB) is difficult; to improve diagnosis, gastric aspiration (GA) was performed in 121 Botswana health facilities.
Objective:
To describe treatment initiation and outcomes in children with a positive GA result and those treated empirically.
Methods:
Children with smear or culture-positive GA or those clinically diagnosed were referred for anti-tuberculosis treatment. Treatment initiation and outcomes were assessed from February 2008 to December 2012 using name-based matching algorithms of the GA database; treatment initiation was captured in the electronic TB registry. Analyses included descriptive statistics and regression models.
Results:
GA was conducted in 1268 children. Among these, 121 (9.5%) were GA-positive; and treatment was initiated in 90 (74.3%). An additional 137 (11.9%) were treated empirically. More than a third (36.4%) had known human immunodeficiency virus status (positive or negative); this was significantly associated with TB treatment initiation (adjusted odds ratio [aOR] 1.8, 95%CI 1.3-2.5); P < 0.05). Among the 90 children with a positive GA result, nearly all either completed treatment (78.9%) or were on treatment (20.0%) at the time of data collection.
Conclusion:
We could not find documentation of treatment for more than a quarter of the children with laboratory-confirmed TB, an important gap that calls for further examination. The failure to initiate prompt treatment requires investigation and urgent action.
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