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ABSTRACT
Background. Childhood tuberculosis (TB) has been neglected by TB programs in Sub-Saharan Africa. The aim of this study was to determine the incidence and predictors of poor outcome in children with TB in the North region of Cameroon. Methods. It was a retrospective cohort study based on hospital TB registers and treatment TB forms, in all of the 18 functional diagnosis and therapeutic centers (DTC) in the North region. All children aged 0-15years, on anti-TB treatment between 2010-2016 were enrolled. Logistic regression was used to find independent factors associated to poor outcome. Results. Of the 668 children included [321 (48.1%) boys], the median (25th-75th percentile) age was 11(6-14) years, with 75.9% children aged >5 years. Pulmonary TB was the most common (62.9%) with 34.3% smear-negative pulmonary TB. Extrapulmonary TB (62.1%) was mostly found in children aged 0-5years. HIV/TB coinfection was 10.3%. Incidence (95%CI) of poor outcome was 4.0 % ( 2.5-5.5%). Predictors [OR (95% CI)] of poor outcome were: HIV positive children [3.995(1.131-14.112), p=0.031], management in peripheral DTC [32.451(4.211-250.099), p=0.001], and transferred in patients from a peripheral zone toward a 3rd or 4th DTC category [4.602(1.092-19.386), p=0.037]. Conclusion. Incidence of poor outcome of childhood TB was quite low in the North region of Cameroon. HIV, peripheral TDC and transferred in patients were predictors of poor outcome. A better management of HIV, retraining DTC personnel and early reference from peripheral DTC would reduce poor outcome among childhood TB.
RÉSUMÉ
Introduction. La tuberculose (TB) de l’enfant a été négligée par les programmes en Afrique Sub-Saharienne. Le but était de déterminer l’incidence et les facteurs prédictifs de devenir défavorable de TB pédiatrique dans la région du Nord Cameroun. Patients et méthodes. Il s’agissait d’une étude de cohorte rétrospective, dans les 18 centres de diagnostic et de traitement (CDT) de la région du Nord Cameroun. Tous les enfants âgés de 0-15ans, traités pour TB de 2010-2016 ont été inclus. La régression logistique était utilisée pour rechercher les facteurs indépendants du devenir défavorable. Résultats. Des 668 enfants inclus [321 (48,1%) garçons], l’âge médian (25th-75th percentile) était de 11(6-14) ans. La TB pulmonaire était la plus représentée (62,9%) avec 34,3% de TB à microscopie négative. La prévalence de la co-infection VIH/TB était de 10,3%. L’incidence (IC à 95%) du devenir défavorable était de 4,0%(2,5-5,5%). Les facteurs prédictifs [OR (IC à 95%)] du devenir défavorable étaient : La séropositivité au VIH [3,995(1,131-14,112), p=0,031], la prise en charge dans les CDT périphériques [32,451(4,211-250,099), p=0,001], et les patients transférés d’un CDT périphérique vers un CDT d’une zone de 3e-4e catégorie [4,602(1,092-19,386), p=0,037]. Conclusion. L’incidence du devenir défavorable au cours de la TB pédiatrique est relativement faible au Nord Cameroun. Le VIH, les CDT périphériques et les transferts sont les facteurs prédictifs du devenir défavorable. Une meilleure prise en charge du VIH, le recyclage du personnel et la référence précoce pourraient réduire le devenir défavorable au cours de la TB de l’enfant.

Keywords

Pediatric tuberculosis incidence predictors poor outcome Cameroon Tuberculose pédiatrique incidence facteurs prédictifs devenir défavorable Cameroun

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Adamou Dodo Balkissou, Fadil Donkou Raouph, Djibril Mohammadou Mubarak, Armel Djao Kora, Kuaban Alain, Eric Walter Pefura-Yone, & Seraphin Nguefack. (2022). Incidence and Predictors of Poor Outcome Among Childhood Tuberculosis in the North of Cameroon.: Poor outcome among childhood tuberculosis. HEALTH SCIENCES AND DISEASE, 23(8). https://doi.org/10.5281/hsd.v23i8.3803
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