Abstract
Abstract
Background
Co-infection of tuberculosis and HIV has a significant impact on public health. TB is the most common opportunistic infection and the leading cause of death in HIV-positive children worldwide. But there is paucity of studies concerning the predictors of mortality among TB-HIV co-infected children. This study aimed to determine the predictors of mortality among TB-HIV co-infected children attending ART clinics of public hospitals in Southern Nation, Nationalities and Peoples Region (SNNPR), Ethiopia.
Methods
A hospital-based retrospective cohort study design was used among 284 TB-HIV co-infected children attending ART clinics at selected public hospitals in SNNPR, Ethiopia, from January 2009 to December 2019. Then, medical records of children who were TB/HIV co-infected and on ART were reviewed using a structured data extraction tool. Data were entered using Epidata 4.6 and analyzed using SPSS version 23. The Kaplan Meier survival curve along with log rank tests was used to estimate and compare survival time. Bivariable and multivariable analyses were conducted to identify predictors of mortality among TB/HIV co-infected children. Adjusted Hazard Ratio with p value < 0.05 and 95% confidence interval was considered statistically significant.
Result
A total of 284 TB/HIV co-infected children were included in the study. Among these, 35 (12.3%) of them died during the study period. The overall mortality rate was 2.78 (95%CI = 1.98-3.99) per 100 child years of observation. The predictors of mortality were anemia (AHR = 3.6; 95%CI: 1.39-9.31), fair or poor ART drug adherence (AHR = 2.9; 95%CI = 1.15-7.43), extrapulmonary TB (AHR = 3.9; 95%CI: 1.34-11.45) and TB drug resistance (AHR = 5.7; 95%CI: 2.07-15.96).
Conclusion
Mortality rate of TB/HIV co-infected children in selected public hospitals in SNNPR, Ethiopia was documented as 2.78 per child years of observation as a result of this study. Moreover, Anemia, drug resistant tuberculosis, extrapulmonary TB and poor adherence to ART drugs were identified as the predictors of mortality among these children.
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health
Reference25 articles.
1. Pan American Health Organization. TB/HIV coinfection regional clinical manual: 2017 Update [Internet]. 2018. 14–91 p. Available from: https://www.paho.org/en/node/58184
2. Kliegman R, Stanton B, Schor N, St Geme J. Nelson textbook of pediatrics - 20th edition (2 Vol set). In: Nelson Textbook of Pediatrics; 2015.
3. European Centre for Disease Prevention and Control. Annual Epidemiological Report for 2016 Key facts. Surveill Rep. 2021;783(January):1–5.
4. UNAIDS and World Health Organization. Quality and Coverage of HIV Sentinel Surveillance With a brief History of the HIV / AIDS Epidemic. World Heal Organ UNAIDS. 2003;(September):8–13.
5. Narendran G, Swaminathan S. TB-HIV co-infection: a catastrophic comradeship. Oral Dis. 2016;22:46–52.