马来西亚使用 MyTB 版本 2.1 数据库五年间儿科结核病患者的特征及其治疗成功的相关决定因素。
Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years.
机构信息
Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia.
出版信息
BMC Public Health. 2020 Dec 10;20(1):1903. doi: 10.1186/s12889-020-10005-y.
BACKGROUND
Tuberculosis (TB) among children remains a significant public health problem in many parts of the world. The objective of this study was to describe the characteristics of TB patients and to determine the predictors of treatment success among children in Malaysia.
METHODS
Secondary data from MyTB version 2.1, a national database, were analysed using R version 3.6.1. Descriptive analysis and multivariable logistic regression were conducted to identify treatment success and its determinants.
RESULTS
In total, 3630 cases of TB cases were registered among children in Malaysia between 2013 and 2017. The overall treatment success rate was 87.1% in 2013 and plateaued between 90.1 and 91.4% from 2014 to 2017. TB treatment success was positively associated with being a Malaysian citizen (aOR = 3.43; 95% CI = 2.47, 4.75), being a child with BCG scars (aOR = 1.93; 95% CI = 1.39, 2.68), and being in the older age group (aOR = 1.06; 95% CI = 1.03, 1.09). Having HIV co-infection (aOR = 0.31; 95% CI = 0.16, 0.63), undergoing treatment in public hospitals (aOR = 0.38; 95% CI =0.25, 0.58), having chest X-ray findings of advanced lesion (aOR = 0.48; 95% CI = 0.33, 0.69), having EPTB (aOR = 0.58; 95% CI = 0.41, 0.82) and having sputum-positive PTB (aOR = 0.58; 95% CI = 0.43, 0.79) were negatively associated with TB treatment success among children.
CONCLUSIONS
The overall success rate of treatment among children with TB in Malaysia has achieved the target of 90% since 2014 and remained plateaued until 2017. The socio-demographic characteristics of children, place of treatment, and TB disease profile were associated with the likelihood of TB treatment success among children. The treatment success rate can be increased by strengthening contact tracing activities and promoting early identification targeting the youngest children and non-Malaysian children.
背景
结核病（TB）在世界许多地区仍是一个严重的公共卫生问题。本研究的目的是描述结核病患儿的特征，并确定马来西亚儿童结核病治疗成功的预测因素。
方法
使用 R 版本 3.6.1 对 MyTB 版本 2.1 中的二次数据进行分析，这是一个国家数据库。进行描述性分析和多变量逻辑回归以确定治疗成功及其决定因素。
结果
2013 年至 2017 年间，马来西亚共登记了 3630 例儿童结核病病例。2013 年总体治疗成功率为 87.1%，2014 年至 2017 年期间稳定在 90.1%至 91.4%之间。结核病治疗成功与以下因素呈正相关：马来西亚公民（优势比[OR] = 3.43；95%置信区间[CI] = 2.47，4.75）、有卡介苗疤痕的儿童（OR = 1.93；95% CI = 1.39，2.68）和年龄较大的儿童（OR = 1.06；95% CI = 1.03，1.09）。HIV 合并感染（OR = 0.31；95% CI = 0.16，0.63）、在公立医院接受治疗（OR = 0.38；95% CI = 0.25，0.58）、胸部 X 光检查显示进展性病变（OR = 0.48；95% CI = 0.33，0.69）、患有 EPTB（OR = 0.58；95% CI = 0.41，0.82）和痰涂片阳性肺结核（OR = 0.58；95% CI = 0.43，0.79）与儿童结核病治疗成功呈负相关。
结论
自 2014 年以来，马来西亚儿童结核病治疗的总体成功率已达到 90%的目标，并保持稳定至 2017 年。儿童的社会人口特征、治疗地点和结核病疾病特征与儿童结核病治疗成功的可能性相关。通过加强接触者追踪活动和针对最年幼儿童和非马来西亚儿童的早期识别，可以提高治疗成功率。
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