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Childhood tuberculosis and treatment outcomes in Accra: a retrospective analysis
Sally-Ann Ohene1, Sarah Fordah2, Prince Dela Boni3
1World Health Organization Country Office, Accra, Ghana. ohenes@who.int.
Insights
Childhood tuberculosis (TB) treatment in Accra shows high success rates, meeting global targets. However, HIV positivity significantly increases mortality risk in young TB patients, highlighting a critical area for intervention.
Area of Science:
- Pediatric infectious diseases
- Global public health
- Tuberculosis research
Background:
- Tuberculosis (TB) remains a major global health threat, particularly impacting children in Africa where data is scarce.
- Understanding childhood TB characteristics and outcomes is crucial for effective public health strategies.
Purpose of the Study:
- To evaluate the demographic and clinical features of pediatric tuberculosis cases in Accra, Ghana.
- To assess treatment outcomes and identify mortality predictors in children with TB.
Main Methods:
- Retrospective analysis of secondary data from 219 children under 15 years diagnosed with TB between June 2010 and December 2013.
- Data collected from 11 health facilities in Accra during a TB case-finding initiative.
- Multivariable logistic regression used to determine factors associated with mortality.
Main Results:
- Children constituted 5.9% of all TB cases, with 56.2% under 5 years old and 44.2% HIV-positive.
- Smear-positive pulmonary TB (SPPTB) was the most common type (46.5%).
- Overall treatment success was 90.7%, but mortality was significantly higher in younger children (1-4 years), SPPTB cases, and HIV-positive children.
Conclusions:
- Treatment success rates for childhood TB in Accra align with the END TB Strategy goals.
- HIV co-infection is a significant risk factor for mortality in children with TB.
- Targeted interventions for TB-HIV co-infected children are essential to further improve pediatric TB outcomes in Accra.
Background:
Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana.
Methods:
A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality.
Results:
Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality.
Conclusion:
The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.
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