Patient characteristics and predictors of mortality among children hospitalised with tuberculosis: A six-year case series study in Uganda

Author:

Amuge Pauline1,Becker Greta L2,Ssebunya Rogers N.1,Nalumansi Esther3,Adaku Alex4,Juma Michael1,Jackson J Brooks5,Kekitiinwa Adeodata R.1,Elyanu Peter1,Wobudeya Eric6,Blount Robert J2

Affiliation:

1. Baylor College of Medicine Children’s Foundation-Uganda, Kampala

2. Division of Pulmonary and Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City

3. Department of Medical records, Mulago National Referral Hospital, Kampala

4. Fort Portal Regional Referral Hospital, Fort Portal City, Kabarole District

5. Department of Pathology, University of Iowa, Iowa City, Iowa

6. Department of Paediatrics & Child Health, Mulago National Referral Hospital, Kampala

Abstract

Abstract Background: The high case-fatality rates among children with tuberculosis (TB) are reportedly driven by in-hospital mortality and severe forms of TB. Therefore, there is need to better understand the predictors of mortality among children hospitalised with TB. We examined the patient clinical profiles, length of hospital stay, and predictors of mortality among children hospitalised with TB at two tertiary hospitals in Uganda. Methods: We conducted a case-series study of children below 15 years of age hospitalised with TB, from January 1st, 2016, to December 31st, 2021. Convenience sampling was done to select TB cases from paper-based medical records at Mulago National Referral Hospital (MNRH) in urban Kampala, and Fort Portal Regional Referral Hospital (FRRH) in rural Fort Portal. We fit linear and logistic regression models with length of stay and in-hospital mortality as outcomes. Results: Out of the 201 children hospitalised with TB, 50 were at FRRH, and 151 at MNRH. The male to female ratio was 1.5 with median age of 2.6 years (Interquartile range-IQR 1-6). There was a high prevalence of HIV (67/171, 39%), severe malnutrition reported as weight-for-age Z-score <-3SD (51/168, 30%). Among children with pulmonary TB who initiated anti-tuberculosis therapy (ATT) either during hospitalisation or within seven days prior to hospitalisation; cough (134/143, 94%), fever (111/143, 78%), and dyspnoea (78/143, 55%) were common symptoms. Children with TB meningitis commonly presented with fever (17/24, 71%), convulsions (14/24 58%), and cough (13/24, 54%). The median length of hospital stay was 8 days (IQR 5-15). Of the 199 children with known in-hospital outcomes, 34 (17.1%) died during hospitalisation. TB meningitis was associated with in-hospital mortality (aOR=3.50, 95% CI=1.10-11.17, p=0.035), while male sex was associated with reduced mortality (aOR=0.33, 95% CI=0.12-0.95, p=0.035). Hospitalisation in the urban hospital predicted a 0.48-day increase in natural log-transformed length of hospital stay (ln-length of stay) (95% CI 0.15- 0.82, p = 0.005), but not age, sex, HIV, malnutrition, or TB meningitis. Conclusions: In-hospital mortality was high, driven by TB meningitis, with longer hospital stay among children in urban hospitals. The high in-hospital mortality and long hospital stay may be reduced by timely TB diagnosis and treatment initiation among children.

Publisher

Research Square Platform LLC

Reference29 articles.

1. World Health Organisation. Global tuberculosis report 2022. Geneva: World Health Organisation. ; 2022. Report No.: Licence: CC BY-NC-SA 3.0 IGO.

2. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review;Tiemersma EW;PLoS ONE,2011

3. Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk factors for tuberculosis. Pulmonary medicine. 2013;2013.

4. Prevalence and risk factors for transmission of infection among children in household contact with adults having pulmonary tuberculosis;Singh M;Arch Dis Child,2005

5. Diagnostic challenges in childhood pulmonary tuberculosis—Optimizing the clinical approach;Gunasekera KS;Pathogens,2022

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