Ngosa Dennis, Lupenga Joseph
Department of Epidemiology and Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia.
Analysis Unit, Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
PLOS Glob Public Health. 2024 Oct 11;4(10):e0002591. doi: 10.1371/journal.pgph.0002591. eCollection 2024.
Treatment outcomes of tuberculosis in children are rarely evaluated. Childhood tuberculosis has been a low priority for tuberculosis programs due to difficulties in diagnosis and treatment. This study evaluated childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals in Lusaka, Zambia from 2015 to 2019. This was a cross-sectional study conducted in eight public hospitals in Lusaka. All children aged 0-14 years, treated with tuberculosis and had treatment outcomes evaluated were included. The WHO tuberculosis treatment outcomes were grouped into successful treatment outcome (cured, treatment completed) and unsuccessful treatment outcome (death, loss to follow-up, failure). Taking unsuccessful treatment outcome as the outcome variable, logistic regression models were performed. All analyses were done at a 95% confidence interval. Out of 2,531 children managed for TB from 2015 to 2019, only 1,495 (59.1%) had treatment outcomes evaluated. Out of 1,495 participants, majority were 5 to 14 years old (50.9%), males (51.1%), HIV-negative (58.7%), and had pulmonary tuberculosis (74.2%). Bacteriological tests were performed on 59.8% of children, where 21.6% had positive bacteriological results. Bacteriologically confirmed TB was higher in children over 5 years (29.5%), pulmonary TB (25.6%), and retreatment (28.6%). The majority of children (84.2%) completed treatment, while 10.7% were cured, 1.5% were lost to follow-up, 3.1% died, and 0.5% failed treatment. Overall, unsuccessful treatment outcome was 5.1% while successful treatment outcome was 94.1%. Extrapulmonary tuberculosis was associated with unsuccessful treatment outcomes (AOR 1.64; 95% CI: 1.02-2.62). The tuberculosis successful treatment outcome met the World Health Organization's threshold goal of 90%. Children with extrapulmonary tuberculosis should be targeted as a high-risk group to improve treatment outcomes. Tracking children whose treatment outcomes were not evaluated would provide more precise estimates of TB treatment outcomes.
儿童结核病的治疗效果很少得到评估。由于诊断和治疗困难，儿童结核病在结核病防治项目中一直未得到高度重视。本研究评估了2015年至2019年赞比亚卢萨卡部分公立医院儿童结核病的治疗效果以及与治疗效果不佳相关的因素。这是一项在卢萨卡八家公立医院开展的横断面研究。纳入了所有年龄在0至14岁、接受过结核病治疗且治疗效果得到评估的儿童。世界卫生组织的结核病治疗效果分为成功治疗效果（治愈、完成治疗）和不成功治疗效果（死亡、失访、治疗失败）。以不成功治疗效果作为结果变量，进行逻辑回归模型分析。所有分析均在95%置信区间下进行。在2015年至2019年接受结核病治疗的2531名儿童中，只有1495名（59.1%）的治疗效果得到了评估。在1495名参与者中，大多数年龄在5至14岁（50.9%），为男性（51.1%），HIV阴性（58.7%），患有肺结核（74.2%）。59.8%的儿童进行了细菌学检测，其中21.6%的细菌学检测结果为阳性。5岁以上儿童（29.5%）、肺结核患者（25.6%）和复治患者（28.6%）中细菌学确诊的结核病比例更高。大多数儿童（84.2%）完成了治疗，10.7%治愈，1.5%失访，3.1%死亡，0.5%治疗失败。总体而言，不成功治疗效果为5.1%，成功治疗效果为94.1%。肺外结核病与不成功治疗效果相关（调整后比值比1.64；95%置信区间：1.02 - 2.62）。结核病成功治疗效果达到了世界卫生组织90%的阈值目标。应将肺外结核病儿童作为高危群体进行针对性治疗，以改善治疗效果。追踪治疗效果未得到评估的儿童将能更精确地估计结核病治疗效果。
