Main Article Content

Abstract


ABSTRACT
Background. Childhood tuberculosis (TB) has been neglected by TB programs in Sub-Saharan Africa. The aim of this study was to determine the incidence and predictors of poor outcome in children with TB in the North region of Cameroon. Methods. It was a retrospective cohort study based on hospital TB registers and treatment TB forms, in all of the 18 functional diagnosis and therapeutic centers (DTC) in the North region. All children aged 0-15years, on anti-TB treatment between 2010-2016 were enrolled. Logistic regression was used to find independent factors associated to poor outcome. Results. Of the 668 children included [321 (48.1%) boys], the median (25th-75th percentile) age was 11(6-14) years, with 75.9% children aged >5 years. Pulmonary TB was the most common (62.9%) with 34.3% smear-negative pulmonary TB. Extrapulmonary TB (62.1%) was mostly found in children aged 0-5years. HIV/TB coinfection was 10.3%. Incidence (95%CI) of poor outcome was 4.0 % ( 2.5-5.5%). Predictors [OR (95% CI)] of poor outcome were: HIV positive children [3.995(1.131-14.112), p=0.031], management in peripheral DTC [32.451(4.211-250.099), p=0.001], and transferred in patients from a peripheral zone toward a 3rd or 4th DTC category [4.602(1.092-19.386), p=0.037]. Conclusion. Incidence of poor outcome of childhood TB was quite low in the North region of Cameroon. HIV, peripheral TDC and transferred in patients were predictors of poor outcome. A better management of HIV, retraining DTC personnel and early reference from peripheral DTC would reduce poor outcome among childhood TB.
RÉSUMÉ
Introduction. La tuberculose (TB) de l’enfant a été négligée par les programmes en Afrique Sub-Saharienne. Le but était de déterminer l’incidence et les facteurs prédictifs de devenir défavorable de TB pédiatrique dans la région du Nord Cameroun. Patients et méthodes. Il s’agissait d’une étude de cohorte rétrospective, dans les 18 centres de diagnostic et de traitement (CDT) de la région du Nord Cameroun. Tous les enfants âgés de 0-15ans, traités pour TB de 2010-2016 ont été inclus. La régression logistique était utilisée pour rechercher les facteurs indépendants du devenir défavorable. Résultats. Des 668 enfants inclus [321 (48,1%) garçons], l’âge médian (25th-75th percentile) était de 11(6-14) ans. La TB pulmonaire était la plus représentée (62,9%) avec 34,3% de TB à microscopie négative. La prévalence de la co-infection VIH/TB était de 10,3%. L’incidence (IC à 95%) du devenir défavorable était de 4,0%(2,5-5,5%). Les facteurs prédictifs [OR (IC à 95%)] du devenir défavorable étaient : La séropositivité au VIH [3,995(1,131-14,112), p=0,031], la prise en charge dans les CDT périphériques [32,451(4,211-250,099), p=0,001], et les patients transférés d’un CDT périphérique vers un CDT d’une zone de 3e-4e catégorie [4,602(1,092-19,386), p=0,037]. Conclusion. L’incidence du devenir défavorable au cours de la TB pédiatrique est relativement faible au Nord Cameroun. Le VIH, les CDT périphériques et les transferts sont les facteurs prédictifs du devenir défavorable. Une meilleure prise en charge du VIH, le recyclage du personnel et la référence précoce pourraient réduire le devenir défavorable au cours de la TB de l’enfant.

Keywords

Pediatric tuberculosis incidence predictors poor outcome Cameroon Tuberculose pédiatrique incidence facteurs prédictifs devenir défavorable Cameroun

Article Details

How to Cite
Adamou Dodo Balkissou, Fadil Donkou Raouph, Djibril Mohammadou Mubarak, Armel Djao Kora, Kuaban Alain, Eric Walter Pefura-Yone, & Seraphin Nguefack. (2022). Incidence and Predictors of Poor Outcome Among Childhood Tuberculosis in the North of Cameroon.: Poor outcome among childhood tuberculosis. HEALTH SCIENCES AND DISEASE, 23(8). Retrieved from https://hsd-fmsb.org/index.php/hsd/article/view/3803

References

  1. Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R, Gopi PG, Selvakumar N, Ganapathy S, Charles N, Rajamma J, et al. Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis 2002;6(9):780–788.
  2. Kuaban C, Pefura-Yone E, Bava D, Onana I. Early mortality in new patients on treatment for smear positive pulmonary tuberculois in Yaounde-Cameroon. Heal Sci Dis 2011 [accessed 2021 Sep 20];12(4). https://www.hsd-fmsb.org/index.php/hsd/article/view/21
  3. WHO. Tuberculosis. [accessed 2020 Jun 9]. https://www.who.int/news-room/fact-sheets/detail/tuberculosis
  4. Marais BJ, Graham SM, Maeurer M, Zumla A. Progress and challenges in childhood tuberculosis. Lancet Infect Dis 2013;13(4):287–289.
  5. Mellado Peña MJ, Santiago García B, Baquero-Artigao F, Moreno Pérez D, Piñeiro Pérez R, Méndez Echevarría A, Ramos Amador JT, Gómez-Pastrana Durán D, Noguera Julian A. Tuberculosis treatment for children: An update. An Pediatría (English Ed 2018;88(1):52.e1-52.e12.
  6. Seddon JA, Schaaf HS. Drug-resistant tuberculosis and advances in the treatment of childhood tuberculosis. Pneumonia 2016;8(1):20.
  7. Chintu C, Mudenda V, Lucas S, Nunn A, Lishimpi K, Maswahu D, Kasolo F, Mwaba P, Bhat G, Terunuma H, et al. Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet (London, England) 2002 [accessed 2020 Jun 9];360(9338):985–90. http://www.ncbi.nlm.nih.gov/pubmed/12383668
  8. Kebede ZT, Taye BW, Matebe YH. Childhood tuberculosis: Management and treatment outcomes among children in northwest Ethiopia: A Cross-Sectional study. Pan Afr Med J 2017;27:25.
  9. Hailu D, Abegaz WE, Belay M. Childhood tuberculosis and its treatment outcomes in Addis Ababa: A 5-years retrospective study. BMC Pediatr 2014;14(1):61.
  10. Ogbudebe CL, Adepoju V, Ekerete-udofia C, Abu E, Egesemba G, Chukwueme N, Gidado M. Childhood Tuberculosis in Nigeria : Disease Presentation and Treatment Outcomes. 2018.
  11. WHO | Tuberculosis country profiles. WHO 2020 [accessed 2020 May 9]. https://www.who.int/tb/country/data/profiles/en/
  12. Sidibe K (CDC) EA (PNLT C. Rapport de mission. In: Evaluation du système de surveillance de la tuberculose et analyse épidémiologique.
  13. Moncef S, Gamara D, Kheder AB, Beji M, Al HB at. Guide De Prise En Charge De La Tuberculose PNLT 2011. Program Natl Lutte contre laTuberculose 2011;4:1–122.
  14. Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019 [accessed 2020 Jun 3];14(12):e0226507. http://www.ncbi.nlm.nih.gov/pubmed/31881023
  15. Ramos JM, Reyes F, Tesfamariam A. Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: A ten-year retrospective study. BMC Public Health 2010;10:215.
  16. Osman M, Lee K, Du Preez K, Dunbar R, Hesseling AC, Seddon JA. Excellent Treatment Outcomes in Children Treated for Tuberculosis under Routine Operational Conditions in Cape Town, South Africa. Clin Infect Dis 2017;65(9):1444–1452.
  17. Afrique du Sud | ONUSIDA. [accessed 2020 Jun 13]. https://www.unaids.org/fr/regionscountries/countries/southafrica
  18. Marais BJ. Childhood tuberculosis: Epidemiology and natural history of disease. Indian J Pediatr 2011;78(3):321–327.
  19. Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis 2008;8(8):498–510.
  20. Duarte R, Lönnroth K, Carvalho C, Lima F, Carvalho ACC, Muñoz-Torrico M, Centis R. Tuberculosis, social determinants and co-morbidities (including HIV). Pulmonology 2018;24(2):115–119.
  21. Lolekha R, Anuwatnonthakate A, Nateniyom S, Sumnapun S, Yamada N, Wattanaamornkiat W, Sattayawuthipong W, Charusuntonsri P, Sanguanwongse N, Wells CD, et al. Childhood TB epidemiology and treatment outcomes in Thailand: A TB active surveillance network, 2004 to 2006. BMC Infect Dis 2008;8:1–9.
  22. Graham SM. Treatment of paediatric TB: Revised WHO guidelines. Paediatr Respir Rev 2011;12(1):22–26.
  23. Tilahun G, Gebre-Selassie S. Treatment outcomes of childhood tuberculosis in Addis Ababa: a five-year retrospective analysis. BMC Public Health 2016;16:612.
  24. Ramos JM, Reyes F, Tesfamariam A. Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: A ten-year retrospective study. BMC Public Health 2010;10:4–11.
  25. Wobudeya E, Lukoye D, Lubega IR, Mugabe F, Sekadde M, Musoke P. Epidemiology of tuberculosis in children in Kampala district, Uganda, 2009-2010; a retrospective cross-sectional study. BMC Public Health 2015 [accessed 2020 Jun 3];15(1):967. http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2312-2
  26. Satyanarayana S, Shivashankar R, Vashist RP, Chauhan LS, Chadha SS, Dewan PK, Wares F, Sahu S, Singh V, Wilson NC, et al. Characteristics and programme-defined treatment outcomes among childhood tuberculosis (TB) patients under the National TB programme in Delhi. PLoS One 2010;5(10):e13338.
  27. Wobudeya E, Jaganath D, Sekadde MP, Nsangi B, Haq H, Cattamanchi A. Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010-2015. BMC Public Health 2019 [accessed 2020 Jun 3];19(1):446. http://www.ncbi.nlm.nih.gov/pubmed/31035984
  28. Bonnet M; Nansumba M; Bastard M; Orikiriza P;Kyomugasho N;Nansera D; Boum Y; de Beaudrap P; Kiwanuka J; Kumbakumba. Outcome of children with presumptive tuberculosis in Mbarara, rural Uganda. Pediatr Infect Dis J 2017;in press:3–30.