Mortality in South African children and adolescents routinely treated for tuberculosis
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Background
In South Africa, tuberculosis (TB) is a leading cause of death among those <20 years. We describe changes in TB mortality amongst children and adolescents in South Africa over a 13-year period, identify risk factors for mortality, and estimate excess TB-related mortality.
Methods
Retrospective analysis of all patients <20 years routinely recorded in the national electronic drug-susceptible TB treatment register (2004-2016). We developed a multivariable Cox regression model for predictors of mortality and used estimates of mortality among the general population to calculate standardized mortality ratios (SMR).
Results
Between 2004-16, 729,463 children and adolescents were recorded on TB treatment; 84.0% had treatment outcomes and 2.5% (18,539) died during TB treatment. The case fatality ratio (CFR) decreased from 3.3% in 2007, to 1.9% in 2016. In the multivariable Cox regression model, age 0-4, 10-14 and 15-19 years (compared to age 5-9 years) was associated with increased risk of mortality, as was HIV infection, previous TB treatment and extrapulmonary involvement. The SMR of 15-19-year-old females was more than double that of males the same age (55.3 vs 26.2). Among 10-14-year-olds and those HIV-positive, SMRs increased over time.
Conclusions
Mortality in South African children and adolescents treated for TB is declining but remains considerable, with 2% dying during 2016. Adolescents (10-19 years) and those people living with HIV have the highest risk of mortality and greatest SMRs. Interventions to reduce mortality during TB treatment, specifically targeting those at highest risk, are urgently needed.
In South Africa, tuberculosis (TB) is a leading cause of death among those <20 years. We describe changes in TB mortality amongst children and adolescents in South Africa over a 13-year period, identify risk factors for mortality, and estimate excess TB-related mortality.
Methods
Retrospective analysis of all patients <20 years routinely recorded in the national electronic drug-susceptible TB treatment register (2004-2016). We developed a multivariable Cox regression model for predictors of mortality and used estimates of mortality among the general population to calculate standardized mortality ratios (SMR).
Results
Between 2004-16, 729,463 children and adolescents were recorded on TB treatment; 84.0% had treatment outcomes and 2.5% (18,539) died during TB treatment. The case fatality ratio (CFR) decreased from 3.3% in 2007, to 1.9% in 2016. In the multivariable Cox regression model, age 0-4, 10-14 and 15-19 years (compared to age 5-9 years) was associated with increased risk of mortality, as was HIV infection, previous TB treatment and extrapulmonary involvement. The SMR of 15-19-year-old females was more than double that of males the same age (55.3 vs 26.2). Among 10-14-year-olds and those HIV-positive, SMRs increased over time.
Conclusions
Mortality in South African children and adolescents treated for TB is declining but remains considerable, with 2% dying during 2016. Adolescents (10-19 years) and those people living with HIV have the highest risk of mortality and greatest SMRs. Interventions to reduce mortality during TB treatment, specifically targeting those at highest risk, are urgently needed.
Date Issued
2021-04-01
Date Acceptance
2020-12-09
Citation
Pediatrics, 2021, 147 (4), pp.1-1
ISSN
0031-4005
Publisher
American Academy of Pediatrics
Start Page
1
End Page
1
Journal / Book Title
Pediatrics
Volume
147
Issue
4
Copyright Statement
Copyright © 2021 by the American Academy of Pediatrics. This document is the Accepted Manuscript version of a published work that appeared in final form in Pediatrics, vol. 147, issue 4.
Identifier
https://pediatrics.aappublications.org/content/147/4/e2020032490
Subjects
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Pediatrics
Publication Status
Published
Article Number
e2020032490
Date Publish Online
2021-04-01