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Childhood TB in China: notification, characteristics and risk factors for outcomes, 2010-2017
1National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
Insights
Childhood tuberculosis (TB) in China remains under-detected, particularly in younger children. Key risk factors for poor outcomes and death include extrapulmonary TB, migrant family status, and prior treatment, necessitating targeted interventions.
Area of Science:
- Epidemiology
- Public Health
- Pediatrics
Background:
- Childhood tuberculosis (TB) presents unique epidemiological challenges globally.
- Understanding treatment outcomes and risk factors is crucial for effective control strategies.
Purpose of the Study:
- To analyze the epidemiology of childhood TB in China from 2010-2017.
- To identify risk factors associated with unfavorable treatment outcomes and mortality in children.
Main Methods:
- Cross-sectional and cohort study designs were employed.
- Log binomial regression was used to assess risk factors for unfavorable outcomes.
- Data from the China National Tuberculosis Programme (2010-2017) were analyzed.
Main Results:
- Of 40,561 children, 19.6% had bacteriologically confirmed TB; 14% were from migrant families.
- Annual TB notification rates were low (<1%), with a halving of bacteriologically confirmed TB notifications.
- Unfavorable outcomes occurred in 6% and deaths in 0.4%; predictors included active case finding, extrapulmonary TB, younger age (<5 years), and previous treatment.
Conclusions:
- Childhood TB in China is significantly under-detected, especially in young children.
- Migrant status, younger age, extrapulmonary disease, and prior treatment are critical risk factors for adverse outcomes and death.
- Addressing under-detection and identified risk factors is essential to achieve zero childhood TB deaths.
Abstract:
SETTING: China National Tuberculosis Programme, 2010-2017.OBJECTIVE: To describe the epidemiology of childhood (age < 15 years) TB, including treatment outcomes and risk factors for unfavourable outcomes and death.DESIGN: We used a cross-sectional design for the descriptive component and a cohort design for treatment outcomes and their risk factors (assessed using log binomial regression).RESULTS: Of 40 561 children, 77.7% (n = 31 529) were aged 10-14 years and 19.6% (n = 7931) were bacteriologically confirmed. Around 14% (n = 5827) belonged to migrant families (internal migration) and 4.0% (n = 1,642) were actively detected. Over 8 years, annual notification was consistently very low (<1%), and notification of bacteriologically confirmed TB decreased by half. Unfavourable outcomes were seen in 6% and deaths in 0.4%; there were no significant changes over the years. The independent predictors of unfavourable outcomes were active case finding and extrapulmonary TB. Children belonging to migrant family were more likely to die. Independent predictors of unfavourable outcomes as well as death were age < 5 years and previous treatment.CONCLUSION: China needs to address the issue of under-detection of childhood TB, especially in younger age groups. The risk factors identified require attention if China is to attain zero child TB deaths.
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