Childhood Tuberculosis: Evaluation Of Clinical Outcomes And Treatment Compliance In Multicenter Hospitals Of Sindh, Pakistan
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Date
2018-07
Authors
Madeeha Laghari
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Pakistan is ranked 11 among the high tuberculosis (TB) burden countries where
TB is rated 6th of top 10 causes of mortality. Although, the national guidelines for the
diagnosis and management of TB in children were established in 2007, but little is
known about the management and treatment outcomes of childhood TB in Pakistan.
For this purpose, children treated under Directly Observed Treatment Short course
(DOTS) at (5) multicentre hospitals of Sindh were recruited as cohort in this
observational study. Total 2,167 children were registered during retrospective phase
from 2011 to 2015 and for prospective phase from 1st June 2016 to 30th November
2016, 508 children were enrolled with TB at the study site. During the study period,
childhood TB accounted 12.2% of all TB cases in Hyderabad, Jamshoro and Matiari
districts. In the present study, 12.1% were bacteriologically confirmed sputum smear
positive cases. At the end of intensive phase, 79.3% of patients achieved sputum smear
conversion. Patients who had household contacts with TB and experienced adverse
effects were significantly less likely to achieve sputum conversion and were more
likely to become sputum positive during the treatment. Around 13.2% of patients came
across with adverse effects. In multivariate analysis females and children with previous
treatment were at greater risk to develop adverse effects due to anti-TB drugs. The
overall treatment success rate was recorded as 93%. Rural residents, sputum smear
positive, children with previous treatment, those who had ADRs and household
contacts with TB emerged as predictors for unsuccessful treatment outcomes.
Treatment adherence among the caregivers using Visual analog scale (VAS) and Morisky Green Levine Medication Adherence Scale (MGLS) in the present study was
recorded as 86% on MGLS and 90.7% with VAS. The principal component analysis
in the current study indicated that the modified MGLS was one-dimensional and the 4
items loaded well onto the single factor. The correlation of VAS with MGLS-U was
0.572 that demonstrates good association between the two scores and the instruments
performed well in caregivers with lower education. Male caregivers, those aged ≥ 45
years, with no formal education, had financial barrier, reported insufficient counselling
by health care workers as well as clinicians and ignorant attitude of health care
professional were observed as contributing factor to non-adherence among caregivers
at the study site. The overall prevalence of TB among household contacts was 1.5%.
Children who had household contacts with TB and smoking were observed at
significantly higher risk for developing TB. Only 33.8% of children who were given
isoniazid preventive therapy (IPT) (26/77) successfully completed the six-month
course. In conclusion, the proportion of 12.2% childhood TB notified in the current
study is alarming. The positively significant associated factors (P < 0.05) of sputum
non-conversion (household contacts with TB and experienced adverse effects),
adverse effects (females and children with previous treatment), unsuccessful treatment
outcomes (Rural residents, sputum smear positive, children with previous treatment,
those who had ADRs and household contacts with TB), and non-adherence (Male
caregivers, those aged ≥ 45 years, with no formal education, had financial barrier,
reported insufficient counselling by health care workers as well as clinicians and
ignorant attitude of health care professional) are practically detectible before or timely
in the course of treatment. The rate of treatment success was promising but can be
further improved by giving significant attention and granting enhanced clinical
management to the high risk patients.
Description
Keywords
Tuberculosis in children