Vukugah Thomas Achombwom, Akoku Derick Akompab, Tchoupa Micheline Mekemnang, Lambert Edward
Atlantic International University, Honolulu, HI, USA.
Health Alliance International, Abidjan, Côte d'Ivoire.
Interdiscip Perspect Infect Dis. 2022 Aug 24;2022:2236110. doi: 10.1155/2022/2236110. eCollection 2022.
In Cameroon, there are limited data on treatment outcomes of pediatric tuberculosis (TB). We sought to identify the factors associated with unsuccessful treatment outcomes and the risk factors for mortality among children receiving TB treatment in the Centre Region of Cameroon.
This was a multicentre facility-based retrospective cohort study using routinely collected programmatic data. All children <15 years old treated for TB between 2018 and 2020 in 21 health facilities were included. We assessed risk factors for experiencing an unsuccessful treatment outcome and mortality through multivariable logistic regression analysis.
Of the 610 children with TB, 307 (50.3%) were females and the median age was 6 years (IQR = 2-12). One hundred and fifty-three (25.1%) of the children were TB/HIV co-infected patients. TB treatment success (cases categorized as cured and completed treatment) was observed in 488 (80.0%) of the patients. Unsuccessful treatment outcomes were experienced by 122 (20.0%) children. Of these, 73 (12.0%) died, 4 (0.6%) had treatment failure, 25 (4.1%) were lost to follow-up, and the outcomes of 20 (3.3%) children were not evaluated. In multivariable analysis, HIV-positive status (adjusted odds ratio [AOR] = 2.43; 95% CI, 1.55-3.80, < 0.001) and clinical method of TB diagnosis (AOR = 2.46; 95% CI, 1.55-3.91, < 0.001] were associated with unsuccessful treatment outcomes. HIV-positive status (AOR = 4.23; 95% CI, 2.44-7.33, < 0.001) and clinical method of TB diagnosis (AOR = 2.22; 95% CI, 1.25-3.91, =0.006) were the risk factors for mortality among children on TB treatment.
The study found that HIV-TB co-infected children and those clinically diagnosed with TB were significantly more likely to have had unsuccessful TB treatment outcomes and mortality. Our findings underscore the need for healthcare workers to closely monitor and support HIV-TB co-infected children on TB treatment. TB/HIV collaborative activities should be strengthened by implementing TB preventive interventions among HIV-infected children.
在喀麦隆，关于儿童结核病治疗结果的数据有限。我们试图确定喀麦隆中部地区接受结核病治疗的儿童中与治疗结果不佳相关的因素以及死亡的危险因素。
这是一项基于多中心机构的回顾性队列研究，使用常规收集的项目数据。纳入了2018年至2020年期间在21家医疗机构接受结核病治疗的所有15岁以下儿童。我们通过多变量逻辑回归分析评估了治疗结果不佳和死亡的危险因素。
在610例结核病儿童中，307例（50.3%）为女性，中位年龄为6岁（四分位间距=2-12岁）。153例（25.1%）儿童为结核病/艾滋病毒合并感染患者。488例（80.0%）患者的结核病治疗成功（病例分类为治愈和完成治疗）。122例（20.0%）儿童治疗结果不佳。其中，73例（12.0%）死亡，4例（0.6%）治疗失败，25例（4.1%）失访，20例（3.3%）儿童的治疗结果未评估。在多变量分析中，艾滋病毒阳性状态（调整后的优势比[AOR]=2.43；95%置信区间，1.55-3.80，<0.001）和结核病临床诊断方法（AOR=2.46；95%置信区间，1.55-3.91，<0.001）与治疗结果不佳相关。艾滋病毒阳性状态（AOR=4.23；95%置信区间，2.44-7.33，<0.001）和结核病临床诊断方法（AOR=2.22；95%置信区间，1.25-3.91，=0.006）是接受结核病治疗儿童死亡的危险因素。
该研究发现，结核病/艾滋病毒合并感染儿童和临床诊断为结核病的儿童治疗结果不佳和死亡的可能性显著更高。我们的研究结果强调，医护人员需要密切监测并支持接受结核病治疗的结核病/艾滋病毒合并感染儿童。应通过对艾滋病毒感染儿童实施结核病预防干预措施来加强结核病/艾滋病毒合作活动。
