Complementary surveillance strategies are needed to better characterise the epidemiology, care pathways and treatment outcomes of tuberculosis in children
Date
2018-03-23
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: 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.
Description
CITATION: 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.
The original publication is available at https://bmcpublichealth.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at https://bmcpublichealth.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Tuberculosis -- Epidemiology -- Cape Town (South Africa), Tuberculosis -- Testing -- Cape Town (South Africa), HIV-positive children -- Cape Town (South Africa), Preschool children -- Cape Town (South Africa)
Citation
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