孟加拉国儿童结核病治疗结果及相关危险因素评估。
Evaluation of treatment outcomes and associated risk factors in children with TB in Bangladesh.
作者信息
Madan A, Kulkarni S, Rahman M M, Hossain F, Kamul M K, Campbell J I, Rahman M T, Creswell J, Hussain H, Roy T, Malik A A, Brooks M B
机构信息
Boston University School of Public Health, Boston, MA, USA.
Boston Medical Center, Boston, MA, USA.
出版信息
Public Health Action. 2025 Mar 1;15(1):26-32. doi: 10.5588/pha.24.0050. eCollection 2025 Mar.
BACKGROUND
Children aged 0-14 years old make up 4% of the total number of people diagnosed with TB in Bangladesh. Local pediatric treatment outcomes and associated factors are poorly understood; further understanding can inform tailored interventions to close delivery gaps.
METHODS
To assess the risk factors for unsuccessful treatment outcomes among children receiving TB treatment in 119 health facilities in Mymensingh Division, we conducted systematic verbal screening from 2018 to 2021. Unsuccessful outcomes, including death, treatment failure, or loss to follow-up (LTFU), were analysed using log-binomial regression to examine the association with demographic and clinical characteristics.
RESULTS
Among 1,967 children with reported outcomes, 99.3% ( = 1,954) were successful. The primary reason for unsuccessful treatment was LTFU ( = 12, 0.6%), followed by treatment failure ( = 1, 0.1%). After controlling for age and sex, children with fever had a reduced risk of unsuccessful outcomes compared to those without fever (RR 0.23, 95% CI 0.06-0.82).
CONCLUSION
Most children with TB were successfully treated. LTFU was the leading reason for unsuccessful treatment outcomes in this cohort. Children with fever were less likely to have unsuccessful treatment outcomes, possibly because they were more intensely engaged in care than children without fever due to their presentation of symptoms. Continued research on pediatric TB presentation and treatment outcomes is essential for developing targeted strategies for early detection and treatment support.
背景
在孟加拉国，0至14岁的儿童占结核病确诊总人数的4%。当地儿童的治疗结果及相关因素尚不清楚；进一步了解有助于制定针对性干预措施，缩小治疗差距。
方法
为评估迈门辛专区119家医疗机构中接受结核病治疗的儿童治疗结果不佳的风险因素，我们在2018年至2021年期间进行了系统的口头筛查。使用对数二项回归分析包括死亡、治疗失败或失访（LTFU）在内的治疗结果不佳情况，以研究其与人口统计学和临床特征的关联。
结果
在报告了治疗结果的1967名儿童中，99.3%（=1954）治疗成功。治疗结果不佳的主要原因是失访（=12，0.6%），其次是治疗失败（=1，0.1%）。在控制年龄和性别后，与无发热的儿童相比，发热儿童治疗结果不佳的风险降低（相对风险0.23，95%置信区间0.06 - 0.82）。
结论
大多数结核病儿童得到了成功治疗。失访是该队列中治疗结果不佳的主要原因。发热儿童治疗结果不佳的可能性较小，可能是因为他们因出现症状而比无发热儿童更积极地接受治疗。持续开展关于儿童结核病表现和治疗结果的研究对于制定早期检测和治疗支持的针对性策略至关重要。
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