Abstract
Background As a vulnerable population, children and adolescents with tuberculosis (TB) are faced with many challenges, even those who live in low TB incidence countries. We aimed to evaluate factors associated with TB treatment outcomes allowing more focused interventions to support this population once diagnosed.
Methods A retrospective cohort study using a nationwide surveillance database was performed in children and adolescents (aged 0–18 years) treated for TB in the Netherlands from 1993 to 2018. Logistic regression analyses were used to estimate adjusted odds ratios (aOR) for associated factors of mortality and loss to follow-up (LTFU).
Results Among 3253 eligible patients with known outcomes, 94.4% (95.9% children and 92.8% adolescents) were cured or completed treatment, 0.7% died during treatment and 4.9% were LTFU. There were no reported treatment failures. Risk factors of death included children aged 2–4 years (aOR 10.42), central nervous system TB (aOR 5.14), miliary TB (aOR 10.25), HIV co-infection (aOR 8.60), re-treated TB cases (aOR 10.12) and drug-induced liver injury (aOR 6.50). Active case-finding was a protective factor of death (aOR 0.13). Risk factors of LTFU were adolescents aged 15–18 years (aOR 1.91), illegal immigrants (aOR 4.28), urban domicile (aOR 1.59), unknown history of TB contact (aOR 1.99), drug-resistant TB (aOR 2.31), single adverse drug reaction (aOR 2.12), multiple adverse drug reactions (aOR 7.84) and treatment interruption >14 days (aOR 6.93). Treatment in recent years (aOR 0.94) and supervision by public health nurses (aOR 0.14) were protective factors of LTFU.
Conclusion Highly successful treatment outcomes were demonstrated in children and adolescents routinely treated for TB. Special attention should be given to specific risk groups to improve treatment outcomes.
Abstract
High success rates for TB treatment were achieved in children and adolescents in the Netherlands. To further optimise care in this population, several risk factors particularly associated with mortality and loss to follow-up have been identified. http://bit.ly/2lLJRTC
Footnotes
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Author contributions: F. Gafar, N. van't Boveneind-Vrubleuskaya, B. Wilffert and J-W.C. Alffenaar contributed to conception and design of the study. F. Gafar undertook data extraction and performed data analysis. F. Gafar, N. van't Boveneind-Vrubleuskaya, O.W. Akkerman, B. Wilffert and J-W.C. Alffenaar interpreted the data. F. Gafar and N. van't Boveneind-Vrubleuskaya drafted the manuscript. B. Wilffert and J-W.C. Alffenaar supervised the entire project. All authors critically revised the manuscript for important intellectual content and approved the final version of the manuscript.
Conflict of interest: F. Gafar has nothing to disclose.
Conflict of interest: N. van't Boveneind-Vrubleuskaya has nothing to disclose.
Conflict of interest: O.W. Akkerman has nothing to disclose.
Conflict of interest: B. Wilffert has nothing to disclose.
Conflict of interest: J-W.C. Alffenaar has nothing to disclose.
Support statement: This study was supported by the University of Groningen and by the Indonesia Endowment Fund for Education (LPDP), which were in no way involved in study design, writing or reviewing of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received July 15, 2019.
- Accepted September 6, 2019.
- Copyright ©ERS 2019