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Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children

dc.contributor.authorDu Preez, Karenen_ZA
dc.contributor.authorSchaaf, H. Simonen_ZA
dc.contributor.authorDunbar, Roryen_ZA
dc.contributor.authorWalters, Elisabettaen_ZA
dc.contributor.authorSwartz, Alveraen_ZA
dc.contributor.authorSolomons, Reganen_ZA
dc.contributor.authorHesseling, Anneke C.en_ZA
dc.date.accessioned2018-03-26T05:21:01Z
dc.date.available2018-03-26T05:21:01Z
dc.date.issued2018-03-23
dc.identifier.citationDu Preez, K., et al. 2018. Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children. BMC Public Health, 18:397, doi:10.1186/s12889-018-5252-9
dc.identifier.issn1471-2458 (online)
dc.identifier.otherdoi:10.1186/s12889-018-5252-9
dc.identifier.urihttp://hdl.handle.net/10019.1/103239
dc.descriptionCITATION: Du Preez, K., et al. 2018. Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children. BMC Public Health, 18:397, doi:10.1186/s12889-018-5252-9.
dc.descriptionThe original publication is available at https://bmcpublichealth.biomedcentral.com
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.
dc.description.abstractBackground: Tuberculosis (TB) in young and HIV-infected children is frequently diagnosed at hospital level. In settings where general hospitals do not function as TB reporting units, the burden and severity of childhood TB may not be accurately reflected in routine TB surveillance data. Given the paucibacillary nature of childhood TB, microbiological surveillance alone will miss the majority of hospital-managed children. The study objective was to combine complementary hospital-based surveillance strategies to accurately report the burden, spectrum and outcomes of childhood TB managed at referral hospital-level in a high TB burden setting. Methods: We conducted a prospective cohort study including all children (< 13 years) managed for TB at a large referral hospital in Cape Town, South Africa during 2012. Children were identified through newly implemented clinical surveillance in addition to existing laboratory surveillance. Data were collected from clinical patient records, the National Health Laboratory Service database, and provincial electronic TB registers. Descriptive statistics were used to report overall TB disease burden, spectrum, care pathways and treatment outcomes. Univariate analysis compared characteristics between children identified through the two hospital-based surveillance strategies to characterise the group of children missed by existing laboratory surveillance. Results: During 2012, 395 children (180 [45.6%] < 2 years) were managed for TB. Clinical surveillance identified 237 (60%) children in addition to laboratory surveillance. Ninety (24.3%) children were HIV co-infected; 113 (29.5%) had weight-for-age z-scores <− 3. Extra-pulmonary TB (EPTB) was diagnosed in 188 (47.6%); 77 (19.5%) with disseminated TB. Favourable TB treatment outcomes were reported in 300/344 (87.2%) children with drugsusceptible and 50/51 (98.0%) children with drug-resistant TB. Older children (OR 1.7; 95% CI 1.0–2.8), children with EPTB (OR 2.3; 95% CI 1.5–3.6) and in-hospital deaths (OR 5.4; 95% CI 1.1–26.9) were more frequently detected by laboratory surveillance. TB/HIV co-infected children were less likely to be identified through laboratory surveillance (OR 0.3; 95% CI 0.2–0.5). Conclusions: The burden and spectrum of childhood TB disease managed at referral hospital level in high burden settings is substantial. Hospital-based surveillance in addition to routine TB surveillance is essential to provide a complete picture of the burden, spectrum and impact of childhood TB in settings where hospitals are not TB reporting units.
dc.description.urihttps://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5252-9
dc.format.extent11 pages
dc.publisherBioMed Central
dc.titleComplementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in childrenen_ZA
dc.typeArticleen_ZA
dc.date.updated2018-03-25T06:31:26Z
dc.description.versionPublisher's version
dc.rights.holderAuthors retain copyright


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