Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia.
School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
PLoS One. 2024 May 9;19(5):e0300731. doi: 10.1371/journal.pone.0300731. eCollection 2024.
The risk factors for tuberculosis (TB) disease development in children remained understudied, particularly in low-income countries like Ethiopia. The objective of this study was to identify determinants of TB disease development in general and in relation to BCG vaccination in children in central Ethiopia.
We employed a 1:1 age-matched case-control design to compare the characteristics of children who developed TB (cases) with those who did not (controls). Data were collected in healthcare facilities in Addis Ababa city, Adama, and Bishoftu towns between September 25, 2021, and June 24, 2022. Two hundred and fifty-six cases were drawn at random from a list of childhood TB patients entered into SPSS software, and 256 controls were selected sequentially at triage from the same healthcare facilities where the cases were treated. A bivariate conditional logistic regression analysis was performed first to select candidate variables with p-values less than or equal to 0.20 for the multivariable model. Finally, variables with a p-value less than 0.05 for a matched adjusted odds ratio (mORadj) were reported as independent determinants of TB disease development.
The mean age of the cases was nine years, while that of the controls was 10 years. Males comprised 126 cases (49.2%) and 119 controls (46.5%), with the remainder being females. Ninety-nine (38.7%) of the cases were not BCG-vaccinated, compared to 58 (22.7%) of the controls. Household TB contact was experienced by 43 (16.8%) of the cases and 10 (3.9%) of the controls. Twenty-two (8.6%) of the cases and six (2.3%) of the controls were exposed to a cigarette smoker in their household. Twenty-two (8.6%) of the cases and three (1.2%) of the controls were positive for HIV. Children who were not vaccinated with BCG at birth or within two weeks of birth had more than twice the odds (mORadj = 2.11, 95% CI = 1.28-3.48) of developing TB compared to those who were. Children who ever lived with a TB-sick family member (mORadj = 4.28, 95% CI = 1.95-9.39), smoking family members (mORadj = 3.15, 95% CI = 1.07-9.27), and HIV-infected children (mORadj = 8.71, 95% CI = 1.96-38.66) also had higher odds of developing TB disease than their counterparts.
Being BCG-unvaccinated, having household TB contact, having a smoker in the household, and being HIV-infected were found to be independent determinants of TB disease development among children.
儿童结核病（TB）发病的危险因素仍未得到充分研究，特别是在埃塞俄比亚等低收入国家。本研究的目的是确定儿童结核病发病的决定因素，包括卡介苗（BCG）接种的情况。
我们采用 1:1 年龄匹配的病例对照设计，比较了在埃塞俄比亚中部发生结核病（病例）和未发生结核病（对照）的儿童的特征。数据于 2021 年 9 月 25 日至 2022 年 6 月 24 日在亚的斯亚贝巴市、阿达玛和比绍夫图镇的医疗机构中收集。从进入 SPSS 软件的儿童结核病患者名单中随机抽取 256 例病例，然后在同一医疗机构的分诊处按顺序抽取 256 例对照。首先进行双变量条件逻辑回归分析，选择 p 值小于或等于 0.20 的候选变量进入多变量模型。最后，报告 p 值小于 0.05 的匹配调整比值比（mORadj）的变量作为结核病发病的独立决定因素。
病例的平均年龄为 9 岁，而对照的平均年龄为 10 岁。男性病例为 126 例（49.2%），对照为 119 例（46.5%），其余为女性。99 例（38.7%）病例未接种 BCG，而对照为 58 例（22.7%）。43 例（16.8%）病例有家庭结核病接触，10 例（3.9%）对照有接触。22 例（8.6%）病例和 6 例（2.3%）对照家中有吸烟者。22 例（8.6%）病例和 3 例（1.2%）对照 HIV 检测呈阳性。出生时或出生后两周内未接种卡介苗的儿童患结核病的几率是接种儿童的两倍多（mORadj=2.11，95%CI=1.28-3.48）。曾与结核病患者同住的家庭（mORadj=4.28，95%CI=1.95-9.39）、有家庭成员吸烟（mORadj=3.15，95%CI=1.07-9.27）和感染 HIV 的儿童（mORadj=8.71，95%CI=1.96-38.66）患结核病的几率也高于对照组。
未接种卡介苗、家庭结核病接触、家庭中有吸烟者和感染 HIV 是儿童结核病发病的独立决定因素。
