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Lo TQ, Matlhare L, Mugisha K, Lere TD, Ho-Foster A, Boyd R, Cavanaugh J, Ncube R, Steenhoff AP, Arscott-Mills T. Initiation of anti-tuberculosis treatment in children following gastric aspirate testing, Botswana, 2008-2012. Int J Tuberc Lung Dis 2019; 23:315-321. [PMID: 30871662 DOI: 10.5588/ijtld.18.0404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Diagnosing pediatric tuberculosis (TB) is difficult; to improve diagnosis, gastric aspiration (GA) was performed in 121 Botswana health facilities. OBJECTIVE To describe treatment initiation and outcomes in children with a positive GA result and those treated empirically. METHODS Children with smear or culture-positive GA or those clinically diagnosed were referred for anti-tuberculosis treatment. Treatment initiation and outcomes were assessed from February 2008 to December 2012 using name-based matching algorithms of the GA database; treatment initiation was captured in the electronic TB registry. Analyses included descriptive statistics and regression models. RESULTS GA was conducted in 1268 children. Among these, 121 (9.5%) were GA-positive; and treatment was initiated in 90 (74.3%). An additional 137 (11.9%) were treated empirically. More than a third (36.4%) had known human immunodeficiency virus status (positive or negative); this was significantly associated with TB treatment initiation (adjusted odds ratio [aOR] 1.8, 95%CI 1.3-2.5); P < 0.05). Among the 90 children with a positive GA result, nearly all either completed treatment (78.9%) or were on treatment (20.0%) at the time of data collection. CONCLUSION We could not find documentation of treatment for more than a quarter of the children with laboratory-confirmed TB, an important gap that calls for further examination. The failure to initiate prompt treatment requires investigation and urgent action.
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Affiliation(s)
- T Q Lo
- Epidemic Intelligence Service, Division of Global Health Protection, Division of TB Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - K Mugisha
- National TB Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - T D Lere
- National TB Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - A Ho-Foster
- Botswana-UPenn Partnership, Gaborone, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - J Cavanaugh
- Division of TB Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - R Ncube
- National TB Programme, Botswana Ministry of Health, Gaborone, Botswana
| | - A P Steenhoff
- Botswana-UPenn Partnership, Gaborone, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - T Arscott-Mills
- Botswana-UPenn Partnership, Gaborone, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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