Muñoz-Sellart Montserrat, Yassin Mohammed A, Tumato Million, Merid Yared, Cuevas Luis E
Liverpool School of Tropical Medicine, Liverpool, UK.
Scand J Infect Dis. 2009;41(6-7):450-5. doi: 10.1080/00365540902865736.
Our study took place at 8 tuberculosis diagnostic and treatment centres in Sidama Zone, southern Ethiopia. Our objectives were to assess the status of TB treatment in children and risk factors associated with unfavourable outcome. A retrospective study was based on information retained in TB registers of the centres. Demographic characteristics and treatment outcome of children registered between 2002 and 2007 were retrieved. Risk factors for unfavourable outcome (failure, default or death) were calculated. Of 851 (165 with smear-positive, 475 smear-negative and 206 extrapulmonary TB) children, 655 (77%) were cured or completed and 124 (14.6%) had unfavourable outcome. Treatment success rate increased with age from 66% in children <5 y old to 81% in 5-9-y-olds and 85% in >/=10-y-olds (p <0.001). 75% of patients with smear-negative TB had favourable outcome compared to 80.6% for smear-positive cases (p =0.06). Age <5 y, lack of smear conversion in the second month and living in rural areas were independent risk factors for unfavourable treatment outcome. In conclusion, the outcome of TB treatment varies with age, residency and smear results. Reporting only cases with smear-positive TB disproportionally excludes a higher proportion of children than adults. Surveillance systems to monitor TB outcome in children need to be improved.
我们的研究在埃塞俄比亚南部锡达马地区的8个结核病诊断和治疗中心开展。我们的目标是评估儿童结核病治疗状况以及与不良结局相关的风险因素。一项回顾性研究基于各中心结核病登记册中留存的信息。检索了2002年至2007年期间登记的儿童的人口统计学特征和治疗结局。计算了不良结局（治疗失败、中断治疗或死亡）的风险因素。在851名儿童中（165名涂片阳性、475名涂片阴性和206名肺外结核），655名（77%）治愈或完成治疗，124名（14.6%）有不良结局。治疗成功率随年龄增长而提高，<5岁儿童为66%，5 - 9岁儿童为81%，≥10岁儿童为85%（p<0.001）。涂片阴性结核病患者75%有良好结局，而涂片阳性病例为80.6%（p = 0.06）。<5岁、第二个月涂片未转阴以及居住在农村地区是治疗不良结局的独立风险因素。总之，结核病治疗结局因年龄、居住地和涂片结果而异。仅报告涂片阳性结核病病例不成比例地排除了比成人更高比例的儿童。需要改进监测儿童结核病结局的监测系统。
