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Factors Determining Treatment Success in Children with Drug-Sensitive Tuberculosis in Ethiopia: A Three-Year

Dereje Habte¹, Yared Tadesse¹, Dereje Bekele²

¹Management Sciences for Health, Addis Ababa, Ethiopia.

The American Journal of Tropical Medicine and Hygiene

|September 22, 2020

Insights

This study found a 92.2% treatment success rate for childhood tuberculosis (TB) in Ethiopia. Factors like age, directly observed treatment (DOT), and HIV status influenced outcomes, while underdosing negatively impacted success.

Area of Science:

Public Health
Infectious Diseases
Pediatrics

Background:

Tuberculosis (TB) remains a significant global health challenge, particularly affecting vulnerable populations like children.
Ethiopia has a high burden of TB, necessitating effective treatment strategies for pediatric cases.
Limited data exists on childhood TB treatment outcomes and determinants within Ethiopia.

Purpose of the Study:

To assess the treatment outcomes of tuberculosis in children under 15 years old in Ethiopia's Amhara and Oromia regions.
To identify determinants influencing the success of TB treatment in pediatric patients.
To provide evidence for improving pediatric TB management strategies.

Main Methods:

Retrospective data collection from 2012-2014 across 40 hospitals and 137 health centers.
Inclusion of 2,557 children diagnosed with various forms of TB (pulmonary, extrapulmonary, bacteriologically confirmed).
Statistical analysis using Chi-square tests, t-tests, and logistic regression to determine treatment success predictors.

Main Results:

A high treatment success rate (TSR) of 92.2% was observed, with a 2.8% death rate.
Older age groups (5-9 and 10-14 years), directly observed treatment (DOT) in health centers, and HIV-negative status were associated with higher treatment success.
Underdosing during the intensive phase of treatment was negatively correlated with treatment success.

Conclusions:

Childhood TB treatment success in the studied regions is high but can be further optimized.
Age, DOT delivery setting, and HIV status are key factors in pediatric TB treatment outcomes.
Recommendations include further research on intensive monitoring, weight-based dosage adjustments, and healthcare worker training for improved pediatric TB management.

Read full analysis

Abstract:

This study in the Amhara and Oromia regions of Ethiopia assessed the outcomes of tuberculosis (TB) treatment among children younger than 15 years. Retrospective data were collected on treatment outcomes and their determinants for children with TB for the cohorts of 2012-2014 enrolled in 40 hospitals and 137 health centers. Chi-square tests, t-tests, and logistic regression were used for the analysis. Of 2,557 children registered, 1,218 (47.6%) had clinically diagnosed pulmonary TB, 1,100 (43%) had extrapulmonary TB, and 277 (8.9%) had bacteriologically confirmed TB. Among all cases, 2,503 (97.9%) were newly diagnosed and 178 (7%) were HIV positive. Two-thirds of the children received directly observed treatment (DOT) in health centers and the remaining one-third, in hospitals. The treatment success rate (TSR) was 92.2%, and the death rate was 2.8%. The childhood TSR was high compared with those reported in focal studies in Ethiopia, but no national TSR report for children exists for comparison. Multivariate analysis showed that being older-5-9 years (adjusted odds ratio [AOR], 95% CI: 2.53, 1.30-4.94) and 10-14 years (AOR, 95% CI: 2.71, 1.40-5.26)-enrolled in DOT in a health center (AOR, 95% CI: 2.51, 1.82-3.48), and HIV negative (AOR, 95% CI: 1.77, 1.07-2.93) were predictors of treatment success, whereas underdosing during the intensive phase of treatment (AOR, 95% CI: 0.54, 0.36-0.82) was negatively correlated with treatment success. We recommend more research to determine if intensive monitoring of children with TB, dosage adjustment of anti-TB drugs based on weight changes, and training of health workers on dosage adjustment might improve treatment outcomes.

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