Aw B, Ade S, Hinderaker S G, Dlamini N, Takarinda K C, Chiaa K, Feil A, Traoré A, Reid T
Programme National de Lutte contre la, Tuberculose et la Lèpre, Nouakchott, Mauritanie.
Université de Parakou, Parakou, Bénin.
Public Health Action. 2017 Sep 21;7(3):199-205. doi: 10.5588/pha.16.0123.
The National Tuberculosis Programme, Mauritania. To compare the diagnosis and treatment outcomes of childhood tuberculosis (TB) cases (aged <15 years) registered between 2010 and 2015 inside and outside Nouakchott, the capital city. This was a retrospective comparative cohort study. A total of 948 children with TB were registered. The registration rate was 10 times higher in Nouakchott. The proportion of children among all TB cases was higher inside than outside Nouakchott (7.5% vs. 4.6%, < 0.01). Under-fives represented 225 (24%) of all childhood TB cases, of whom 204 (91%) were registered in Nouakchott. Extra-pulmonary TB was more common in Nouakchott, while smear-negative TB was less common. Treatment success was similar inside and outside Nouakchott (national rate 61%). The principal unsuccessful outcomes were loss to follow-up outside Nouakchott (21% vs. 11%, < 0.01) while transfers out were more common in the city (25% vs. 14%, = 0.01). Being aged <5 years (OR 1.2, 95%CI 1.1-1.5) was associated with an unsuccessful outcome. This study indicates problems in the diagnosis and treatment of childhood TB in Mauritania, especially outside the city of Nouakchott. We suggest strengthening clinical diagnosis and management, improving communications between TB treatment centres and health services and pressing the TB world to develop more accurate and easy-to-use diagnostic tools for children.
毛里塔尼亚国家结核病规划。为比较2010年至2015年期间在首都努瓦克肖特内外登记的儿童结核病（年龄<15岁）病例的诊断和治疗结果。这是一项回顾性比较队列研究。共登记了948例儿童结核病患者。努瓦克肖特的登记率高出10倍。所有结核病病例中儿童的比例在努瓦克肖特市内高于市外（7.5%对4.6%，<0.01）。五岁以下儿童占所有儿童结核病病例的225例（24%），其中204例（91%）在努瓦克肖特登记。肺外结核在努瓦克肖特更为常见，而涂片阴性结核则较少见。努瓦克肖特市内和市外的治疗成功率相似（全国率61%）。主要的治疗失败结果是在努瓦克肖特市外失访（21%对11%，<0.01），而转出在市内更为常见（25%对14%，=0.01）。年龄<5岁（比值比1.2，95%置信区间1.1 - 1.5）与治疗失败结果相关。本研究表明毛里塔尼亚儿童结核病的诊断和治疗存在问题，尤其是在努瓦克肖特市外。我们建议加强临床诊断和管理，改善结核病治疗中心与卫生服务机构之间的沟通，并促使结核病领域开发更准确、易用的儿童诊断工具。
