T Q Lo1, L Matlhare2, K Mugisha3, T D Lere3, A Ho-Foster4, R Boyd5, J Cavanaugh6, R Ncube3, A P Steenhoff7, T Arscott-Mills7. 1. Epidemic Intelligence Service, Division of Global Health Protection, Division of TB Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA. 2. Botswana-UPenn Partnership, Gaborone. 3. National TB Programme, Botswana Ministry of Health, Gaborone, Botswana. 4. Botswana-UPenn Partnership, Gaborone, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. 5. CDC, Gaborone, Botswana. 6. Division of TB Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA. 7. Botswana-UPenn Partnership, Gaborone, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Abstract
SETTING: Diagnosing pediatric tuberculosis (TB) is difficult; to improve diagnosis, gastric aspiration (GA) was performed in 121 Botswana health facilities. OBJECTIVE: To describe treatment initiation and outcomes in children with a positive GA result and those treated empirically. METHODS: Children with smear or culture-positive GA or those clinically diagnosed were referred for anti-tuberculosis treatment. Treatment initiation and outcomes were assessed from February 2008 to December 2012 using name-based matching algorithms of the GA database; treatment initiation was captured in the electronic TB registry. Analyses included descriptive statistics and regression models. RESULTS: GA was conducted in 1268 children. Among these, 121 (9.5%) were GA-positive; and treatment was initiated in 90 (74.3%). An additional 137 (11.9%) were treated empirically. More than a third (36.4%) had known human immunodeficiency virus status (positive or negative); this was significantly associated with TB treatment initiation (adjusted odds ratio [aOR] 1.8, 95%CI 1.3-2.5); P < 0.05). Among the 90 children with a positive GA result, nearly all either completed treatment (78.9%) or were on treatment (20.0%) at the time of data collection. CONCLUSION: We could not find documentation of treatment for more than a quarter of the children with laboratory-confirmed TB, an important gap that calls for further examination. The failure to initiate prompt treatment requires investigation and urgent action.
SETTING: Diagnosing pediatric tuberculosis (TB) is difficult; to improve diagnosis, gastric aspiration (GA) was performed in 121 Botswana health facilities. OBJECTIVE: To describe treatment initiation and outcomes in children with a positive GA result and those treated empirically. METHODS: Children with smear or culture-positive GA or those clinically diagnosed were referred for anti-tuberculosis treatment. Treatment initiation and outcomes were assessed from February 2008 to December 2012 using name-based matching algorithms of the GA database; treatment initiation was captured in the electronic TB registry. Analyses included descriptive statistics and regression models. RESULTS: GA was conducted in 1268 children. Among these, 121 (9.5%) were GA-positive; and treatment was initiated in 90 (74.3%). An additional 137 (11.9%) were treated empirically. More than a third (36.4%) had known human immunodeficiency virus status (positive or negative); this was significantly associated with TB treatment initiation (adjusted odds ratio [aOR] 1.8, 95%CI 1.3-2.5); P < 0.05). Among the 90 children with a positive GA result, nearly all either completed treatment (78.9%) or were on treatment (20.0%) at the time of data collection. CONCLUSION: We could not find documentation of treatment for more than a quarter of the children with laboratory-confirmed TB, an important gap that calls for further examination. The failure to initiate prompt treatment requires investigation and urgent action.
Authors: L Ketema; Z G Dememew; D Assefa; T Gudina; A Kassa; T Letta; B Ayele; Y Tadesse; B Tegegn; D G Datiko; C Negeri; A Bedru; E Klinkenberg Journal: PLoS One Date: 2020-11-19 Impact factor: 3.240