Regional trends in childhood tuberculosis case notification and treatment outcomes: Tanzania, 2018-2023

Globally, one-in-two childhood tuberculosis (TB) case remains undiagnosed, and TB remains a leading cause of death among children under 15 years despite favorable treatment outcomes. This study assessed trends in case notification and outcomes among children with TB across ten regions of Tanzania.

We conducted a retrospective cross-sectional study using data from Tanzania's national electronic TB and Leprosy System for children diagnosed between 2018 and 2023. Mann-Kendall Tests were used to assess the existence of monotonic trends in TB notifications, and distribution of outcomes was analyzed using Wilcoxon rank-sum test or Pearson's Chi-squared test, and binary logistic regression at a 5% significance level.

25,449 childhood TB cases were notified over six-year period, with 14.4% (n = 3667) HIV/TB co-infected. Case notifications increased from 2688 in 2018 to a peak of 5421 in 2022 then declined to 4493 in 2023 (p = 0.047). Significant differences in unfavorable treatment outcomes were observed between pre- and post-COVID-19 periods (OR 0.52, 95% CI 0.44-0.60). TB/HIV co-infection cases declined from 28.5% (n = 766) in 2018 to 8.9% (n = 400) in 2023 (p = 0.002), while HIV-negative cases rose markedly (p = 0.027). Overall, 97.2% of children achieved favorable outcomes. Unfavorable outcomes were common among children who were HIV/TB co-infected, under five years, and 10-15 years.

Childhood TB case notifications increased significantly from 2018 to 2023, indicating improved detection, though with notable regional and HIV-related disparities. Treatment outcomes were generally favorable. HIV-positive children and older age groups faced higher risks of unfavorable outcomes. Targeted interventions are needed to address disparities in case detection and treatment success.