Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010–2015
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
BMC public health
Abstract
Childhood tuberculosis (TB) diagnoses often lack microbiologic confirmation and require empiric
treatment. Barriers to empiric treatment include concern for poor outcomes and adverse effects. We thus
determined the outcomes of empiric TB treatment from a retrospective cohort of children at a national referral
hospital in Kampala, Uganda from 2010 to 2015. Methods: Children were diagnosed clinically and followed through treatment. Demographics, clinical data, outcome and any adverse events were extracted from patient charts. A favorable outcome was defined as a child completing treatment with clinical improvement. We performed logistic regression to assess factors associated with loss to follow up and death. Results: Of 516 children, median age was 36 months (IQR 15–73), 55% (95% CI 51–60%) were male, and HIV prevalence was 6% (95% CI 4–9%). The majority (n = 422, 82, 95% CI 78–85%) had a favorable outcome, with no
adverse events that required treatment discontinuation. The most common unfavorable outcomes were loss to
follow-up (57/94, 61%) and death (35/94, 37%; overall mortality 7%). In regression analysis, loss to follow up was
associated with age 10–14 years (OR 2.38, 95% CI 1.15–4.93, p = 0.02), HIV positivity (OR 3.35, 95% CI 1.41–7.92,
p = 0.01), hospitalization (OR 4.14, 95% CI 2.08–8.25, p < 0.001), and living outside of Kampala (OR 2.64, 95% CI
1.47–4.71, p = 0.001). Death was associated with hospitalization (OR 4.57, 95% CI 2.0–10.46, p < 0.001), severe
malnutrition (OR 2.98, 95% CI 1.07–8.27, p = 0.04), baseline hepatomegaly (OR 4.11, 95% CI 2.09–8.09, p < 0.001),
and living outside of Kampala (OR 2.41, 95% CI 1.17–4.96, p = 0.02). Conclusions: Empiric treatment of child TB was effective and safe, but treatment success remained below the 90% target. Addressing co-morbidities and improving retention in care may reduce unfavorable outcomes.
Description
Keywords
Child, Tuberculosis, Treatment, Outcomes
Citation
Wobudeya, E., Jaganath, D., Sekadde, M. P., Nsangi, B., Haq, H., & Cattamanchi, A. (2019). Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010–2015. BMC public health, 19(1), 1-6. https://doi.org/10.1186/s12889-019-6821-2