Tuberculosis/HIV Prevalence and Treatment Success Among Children Receiving Care in Two Tertiary Health Facilities Within Ogun State, Nigeria.

Background: About 1 million children become ill with tuberculosis every year, representing 10-12% of all cases of tuberculosis notified globally. HIV infection in children increases their risk of having tuberculosis. Sub-Sahara Africa has one of the highest TB incidences and HIV prevalence thus children in this region bear a huge burden of TB/HIV infection. In addition, the treatment success rate in many countries is rarely disaggregated to evaluate children. Thus, this study aims to determine the prevalence of TB/HIV coinfection and treatment success among children with tuberculosis attending clinics in two tertiary institutions in Ogun State, Nigeria.

Methodology: The study was a retrospective cohort study of routine programme data of all children diagnosed and treated for tuberculosis from January 2015 to June 2017 in two tertiary hospitals in Ogun State, Nigeria. The hospitals were Olabisi Onabanjo University Teaching Hospital Sagamu and Federal Medical Centre Abeokuta, Ogun State. Data were retrieved from the facility TB register and analyzed using epi info.

Results: A total of 759 patients were registered for treatment at the two tertiary facilities between January 2015 and June 2017. Of these, 112(14.8%) were children 0-14 years of age. Most of the children (95.54%) had pulmonary tuberculosis. Treatment success was 81.3%. About half (46.4%) of the patients were HIV positive. Age, site of disease, bacteriological diagnosis, and weight at the commencement of treatment were significantly associated with HIV status while none of the socio-demographic variables was associated with treatment outcome.

Conclusion: There is a need to further improve the current treatment success rate of children with tuberculosis. There should be increased efforts to find better ways of diagnosing childhood tuberculosis. The high HIV rate among children with TB is of concern and strategies should be put in place to prevent HIV transmission to children.

研究背景：每年约有100万儿童罹患肺结核（Tuberculosis, TB），占全球报告肺结核病例总数的10%~12%。儿童感染人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）会提升其罹患肺结核的风险。撒哈拉以南非洲是全球肺结核发病率与HIV感染率最高的区域之一，因此该地区儿童承受着沉重的结核/HIV（TB/HIV）合并感染负担。此外，诸多国家极少拆分统计儿童肺结核的治疗成功率以开展相关评估。本研究旨在针对尼日利亚奥贡州两所三级医疗机构就诊的肺结核患儿，明确其结核/HIV合并感染率与治疗成功率。
研究方法：本研究为回顾性队列研究，数据来源于尼日利亚奥贡州两所三级医院2015年1月至2017年6月期间所有确诊并接受肺结核治疗的儿童的常规项目数据。两所医院分别为萨加穆奥拉比西·奥班约大学教学医院（Olabisi Onabanjo University Teaching Hospital Sagamu）以及奥贡州阿贝奥库塔联邦医疗中心（Federal Medical Centre Abeokuta）。研究数据从机构肺结核登记册中提取，并采用Epi Info软件进行分析。
研究结果：2015年1月至2017年6月期间，两所三级医疗机构共登记759例接受肺结核治疗的患者，其中112例（14.8%）为0~14岁儿童。绝大多数患儿（95.54%）罹患肺结核。整体治疗成功率为81.3%，约半数（46.4%）患者HIV检测呈阳性。患儿的年龄、病变部位、细菌学诊断结果以及治疗开始时的体重，均与HIV感染状态存在显著关联；而所有社会人口学变量均与治疗结局无显著关联。
研究结论：当前儿童肺结核的治疗成功率仍有待进一步提升。需加大力度探索更优的儿童肺结核诊断方案。肺结核患儿中较高的HIV感染率令人担忧，应制定相关策略以阻断HIV向儿童的传播。