Low case notification rates of childhood tuberculosis in southern Ethiopia

BMC Pediatrics

Bernt Lindtjørn³  Daniel Gemechu Datiko²  Mesay Hailu Dangisso¹ 

[1] Hawassa University, Hawassa, Ethiopia;Liverpool School of Tropical Medicine, Liverpool, UK;Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen Armauer Hansen Building, Bergen, N-5012, Norway

关键词: Ethiopia;    Sidama;    Treatment outcome;    Childhood TB case notification;    Childhood tuberculosis;   

Others  :  1234558
DOI  :  10.1186/s12887-015-0461-1

 received in 2014-12-02, accepted in 2015-09-22,  发布年份 2015

【 摘 要 】

Background

Childhood tuberculosis (TB) is a public health concern causing considerable mortality. However, control of childhood TB receives little attention. The control efforts could be inadequate because of challenges associated with difficulties in diagnosing the disease in children. Understanding the burden of the disease among children is important to assess the ongoing transmission of the disease in a community and improving TB control efforts. This study was carried out to assess TB case notification rates (CNRs) and treatment outcomes in children aged less than 15 years over a ten-year period.

Methods

Data were collected from unit TB registers from all health facilities providing TB treatment in the Sidama Zone in Ethiopia. We analysed the CNRs and treatment outcomes by age category, gender, and place of residence. We used logistic regression analysis to identify factors associated with treatment outcomes and to control for confounding.

Results

A total of 4,656 cases of children less than 15 years of age were notified as diagnosed and treated for TB, constituting 13 % of all notified TB cases in the study area. The mean CNRs per 100,000 children less than 15 years were 30 for all new cases of TB, 28 for rural cases, 67 for urban cases, 28 in boys, and 32 in girls. The proportions of treatment success were 82 % for new and 77 % for retreatment cases for the entire study period and increased to 93 % for new cases in 2012 (X ²_trend , P < 0.001). Children less than five years old had a lower treatment success [adjusted odds ratio (AOR) 0.64 (95 % CI, 0.52-0.80)] and higher deaths [AOR 2 (95 % CI, 1.27–3.12)]. The proportion of children who died during treatment among children in the less than 2-year-old age group was three times higher than children in the 2 year and above age groups [AOR 3.34 (95 % CI, 1.92–5.82)].

Conclusion

The CNRs of childhood TB were low in Sidama. Children less than 5 years old had a higher proportion of deaths. Efforts need to be made to improve the diagnosis and treatment of TB among children.

【 授权许可】

   
2015 Dangisso et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Donald PR. Children and tuberculosis: protecting the next generation? Lancet. 1999; 353(9157):1001-1002.
• [2]WHO. Global tuberculosis report. World Health Organization. Geneva; 2014.
• [3]Seddon JA, Shingadia D. Epidemiology and disease burden of tuberculosis in children: a global perspective. Infect Drug Resist. 2014; 7:153-165.
• [4]Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis. 2008; 8(8):498-510.
• [5]Graham SM, Gie RP, Schaaf HS, Coulter JB, Espinal MA, Beyers N. Childhood tuberculosis: clinical research needs. Int J Tuberc Lung Dis. 2004; 8(5):648-657.
• [6]Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis. 2004; 8(5):636-647.
• [7]Brent AJ. Childhood TB surveillance: bridging the knowledge gap to inform policy. J Trop Med. 2012; 2012:865436.
• [8]Kebede AH, Alebachew Z, Tsegaye F, Lemma E, Abebe A, Agonafir M et al.. The first population-based national tuberculosis prevalence survey in Ethiopia, 2010-2011. Int J Tuberc Lung Dis. 2014; 18(6):635-639.
• [9]Marais BJ, Obihara CC, Warren RM, Schaaf HS, Gie RP, Donald PR. The burden of childhood tuberculosis: a public health perspective. Int J Tuberc Lung Dis. 2005; 9(12):1305-1313.
• [10]CSA, ICF International Calverton M, USA: Ethiopia Demograhic and Health Survey 2011. Central Statistical Agency of Ethiopia. Addis Ababa; 2012
• [11]Yassin MA, Datiko DG, Tulloch O, Markos P, Aschalew M, Shargie EB et al.. Innovative community-based approaches doubled tuberculosis case notification and improve treatment outcome in Southern Ethiopia. PLoS ONE. 2013; 8(5):e63174.
• [12]Federal Ministry of Health: Tuberculosis, Leprosy and TB/HIV Prevention and Control Program Manual. World Health Organization. Addis Ababa; 2008.
• [13]Shargie EB, Yassin MA, Lindtjorn B. Quality control of sputum microscopic examinations for acid fast bacilli in southern Ethiopia. Ethiop J Health Dev. 2005; 19(2):104-108.
• [14]Central statistical Agency of Ethiopia: Population. World Health Organization. Addis Ababa; 2012.
• [15]Rie V, Bayers N, Gie RP, Kunneke M, Zietsman L, Donald PR. Childhood tuberculosis in an urban population in South Africa: burden and risk factor. Arch Dis Child. 1999; 80:433-437.
• [16]Harries AD, Hargreaves NJ, Graham SM, Mwansambo C, Kazembe P, Broadhead RL et al.. Childhood tuberculosis in Malawi: nationwide case-finding and treatment outcomes. Int J Tuberc Lung Dis. 2002; 6(5):424-431.
• [17]Marais BJ. Childhood tuberculosis: epidemiology and natural history of disease. Indian J Pediatr. 2011; 78:321-327.
• [18]Graham SM, Ahmed T, Amanullah F, Browning R, Cardenas V, Casenghi M et al.. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel. J Infect Dis. 2012; 205 Suppl 2:S199-208.
• [19]Britton P, Perez-Velez CM, Marais BJ. Diagnosis, treatment and prevention of tuberculosis in children. N S W Public Health Bull. 2013; 24(1):15-21.
• [20]Marais BJ, Gie RP, Schaaf HS, Beyers N, Donald PR, Starke JR. Childhood pulmonary tuberculosis: old wisdom and New challenges. Am J Respir Crit Care Med. 2006; 173:1078-1090.
• [21]Mtabho CM, Irongo CF, Boeree MJ, Aarnoutse RE, Kibiki GS. Childhood tuberculosis in the Kilimanjaro region: lessons from and for the TB programme. Trop Med Int Health. 2010; 15(5):496-501.
• [22]Dangisso MH, Datiko DG, Lindtjorn B. Trends of tuberculosis case notification and treatment outcomes in the sidama zone, southern ethiopia: ten-year retrospective trend analysis in urban-rural settings. PLoS ONE. 2014; 9(12):e114225.
• [23]Munoz-Sellart M, Yassin MA, Tumato M, Merid Y, Cuevas LE. Treatment outcome in children with tuberculosis in southern Ethiopia. Scand J Infect Dis. 2009; 41(6-7):450-455.
• [24]Hailu D, Abegaz WE, Belay M. Childhood tuberculosis and its treatment outcomes in Addis Ababa: a 5-years retrospective study. BMC Pediatr. 2014; 14:61. BioMed Central Full Text
• [25]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. BioMed Central Full Text
• [26]Donald PR, Marais BJ, Barry 3rd CE. Age and the epidemiology and pathogenesis of tuberculosis. Lancet. 2010;375(9729):1852–4.
• [27]Lolekha R, Anuwatnonthakate A, Nateniyom S, Sumnapun S, Yamada N, Wattanaamornkiat W et al.. Childhood TB epidemiology and treatment outcomes in Thailand: a TB active surveillance network, 2004 to 2006. BMC Infect Dis. 2008; 8:94. BioMed Central Full Text
• [28]Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F. Factors associated with default from treatment among tuberculosis patients in Nairobi province Kenya: a case control study. BMC Public Health. 2011; 11:696. BioMed Central Full Text
• [29]Global Alliance for TB Drug Development. Improving treatment for children with TB. http://www. tballiance.org/children/treatment/ webcite
• [30]Wu XR, Yin QQ, Jiao AX, Xu BP, Sun L, Jiao WW et al.. Pediatric tuberculosis at Beijing Children’s Hospital: 2002-2010. Pediatrics. 2012; 130(6):e1433-1440.
• [31]Federal Ministry of Health: HMIS indicator definitions and technical standards. World Health Organization. Addis Ababa; 2014.
• [32]Sidama Zone Health Department: Sidama Z one health department annual report. World Health Organization. Hawassa, Ethiopia; 2012