Karim M R, Rahman M A, Mamun S A A, Alam M A, Akhter S
Department of Epidemiology, National Institute of Preventive and Social Medicine, Mohakhali, Dhaka.
Bangladesh Med Res Counc Bull. 2012 Apr;38(1):27-32. doi: 10.3329/bmrcb.v38i1.10449.
Childhood tuberculosis is one of the major causes of childhood mortality and morbidity though much neglected within our National Tuberculosis Control Program. This case control study was carried out to identify the risk factors for tuberculosis among children. Cases (n=95) and controls (n=94) were selected from Directly Observed Treatment Short Course (DOTS) centers of four upazillas of Dhaka and Gazipur districts. Cases were childhood tuberculosis patient, who were test positive by sputum microscopy from January to May, 2011 and controls were children who visited DOTS laboratory suspecting tuberculosis infection but were sputum negative. Both cases and controls were selected from the sputum examination registers and were traced at home for exposure data. The study showed more girls were infected than boys. Several socio demographic and environmental factors were found to be associated with the development of childhood tuberculosis. Logistic regression model was constructed to find out the important predictors which revealed age, education of the respondents, indoor environment and contact pattern were significantly associated with childhood tuberculosis. Children more than 14 years of age had 6.25 times higher risk of developing childhood tuberculosis; (Odds ratio=6.25; 95% CI for OR=2.00 to 19.55), Children completed primary education had 3.12 times lower risk of developing childhood tuberculosis, (Odds ratio=.32; 95% CI for OR=.10 to 1.00). Those who resided in better in-house environment had 4.35 times lower risk of developing childhood tuberculosis (Odds ratio=.23; 95% CI for OR=.06 to .95) and children came in contact with source tuberculosis cases who were their relatives or neighbors were 5.26 times lower risk of developing childhood tuberculosis than being in contact with family members with TB (Odds ratio=.19; 95% CI for OR=.07 to .49). Contact Screening should be incorporated in National TB program for early detection and effective treatment of tuberculosis. Improvement of indoor environment and ventilation status of the bedroom might reduce the risk of developing childhood tuberculosis.
儿童结核病是儿童死亡和发病的主要原因之一，尽管在我国国家结核病控制规划中受到很大忽视。开展这项病例对照研究是为了确定儿童结核病的危险因素。病例（n = 95）和对照（n = 94）选自达卡和加济布尔地区四个乡的直接观察短程治疗（DOTS）中心。病例为儿童结核病患者，他们在2011年1月至5月期间痰涂片显微镜检查呈阳性，对照为到DOTS实验室怀疑有结核感染但痰检阴性的儿童。病例和对照均从痰检登记册中选取，并追踪到其家中获取暴露数据。研究表明，感染结核病的女孩比男孩多。发现若干社会人口学和环境因素与儿童结核病的发生有关。构建了逻辑回归模型以找出重要的预测因素，结果显示年龄、受访者的教育程度、室内环境和接触模式与儿童结核病显著相关。14岁以上儿童患儿童结核病的风险高6.25倍；（比值比 = 6.25；比值比的95%置信区间为2.00至19.55），完成小学教育的儿童患儿童结核病的风险低3.12倍，（比值比 = 0.32；比值比的95%置信区间为0.10至1.00）。居住在较好室内环境中的儿童患儿童结核病的风险低4.35倍（比值比 = 0.23；比值比的95%置信区间为0.06至0.95），与亲属或邻居等结核病源病例接触的儿童患儿童结核病的风险比与结核病家庭成员接触的儿童低5.26倍（比值比 = 0.19；比值比的95%置信区间为0.07至0.49）。应将接触者筛查纳入国家结核病规划，以便早期发现和有效治疗结核病。改善室内环境和卧室通风状况可能会降低儿童患结核病的风险。
