World Health Organization Country Office, Accra, Ghana.
Ghana Health Service, Kumasi, Ghana.
BMC Infect Dis. 2019 Aug 28;19(1):749. doi: 10.1186/s12879-019-4392-6.
Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana.
A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality.
Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality.
The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.
结核病（TB）是导致儿童和成人死亡的主要原因。与成人不同，非洲的一些国家缺乏儿童结核病的数据。本研究的目的是评估加纳阿克拉多家医疗机构的儿童结核病患者的特征和治疗结局。
对 2010 年 6 月至 2013 年 12 月在阿克拉进行的结核病病例发现活动中从 11 家医疗机构收集的 11 岁以下儿童结核病病例的二级数据进行回顾性分析。评估人口统计学和临床特征以及治疗结局。采用多变量逻辑回归分析评估死亡率的预测因素。
在报告的 3704 例结核病病例中，5.9%（219 例）为儿童，女性：男性比例为 1:1.1。5 岁以下儿童占患者的 56.2%，44.2%为 HIV 阳性。结核病类型分布如下：涂片阳性肺结核（SPPTB）占 46.5%，临床诊断肺结核占 36.4%，肺外结核占 17.4%。在记录了治疗结局的 214 名儿童（97.7%）中，有 214 名（90.7%）成功治疗，其中 81.3%完成治疗，9.4%治愈。18 名儿童（8.4%）死亡。1-4 岁组死亡率显著较高（p<0.001），SPPTB 患儿死亡率较高（p<0.001），HIV 阳性儿童死亡率较高（p<0.001）。在逻辑回归中，SPPTB 和 HIV 阳性是死亡的预测因素。
阿克拉成功治疗结核病的儿童比例达到终结结核病战略治疗成功指标。HIV 阳性是死亡的危险因素。降低结核-艾滋病毒合并感染儿童的死亡率将进一步提高阿克拉儿童结核病的治疗结局。
