Virginie Poka-Mayap, Reine Charlye Dombu-Guiafaing, Adamou Dodo Balkissou, Laurent-Mireille Endale Mangamba, Alain Kuaban, Abdou Wouliyou Nsounfon, Massongo Massongo, Marie Elisabeth Ngah Komo, Arnaud Laurel Ntyo'o Nkoumou, Eric Walter Pefura-Yone
{"title":"儿童结核病不良结局的趋势和决定因素：来自喀麦隆20年队列的见解。","authors":"Virginie Poka-Mayap, Reine Charlye Dombu-Guiafaing, Adamou Dodo Balkissou, Laurent-Mireille Endale Mangamba, Alain Kuaban, Abdou Wouliyou Nsounfon, Massongo Massongo, Marie Elisabeth Ngah Komo, Arnaud Laurel Ntyo'o Nkoumou, Eric Walter Pefura-Yone","doi":"10.1136/bmjresp-2025-003292","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a leading cause of childhood morbidity and mortality in resource-limited settings. Despite progress in TB care, unfavourable treatment outcome persists, highlighting the need to identify determinants and address gaps in paediatric TB management. This study aimed to assess treatment outcomes and identify determinants of unfavourable outcomes in children treated for TB at a referral centre in Cameroon.</p><p><strong>Methods: </strong>This retrospective cohort study included children aged <15 years diagnosed with TB and followed at the Jamot Hospital of Yaoundé from 2001 to 2020. Treatment outcome was classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure or loss to follow-up). Sociodemographic and clinical data were recorded. A Poisson regression model was applied to evaluate temporal trends in the annual incidence of unfavourable outcomes. Logistic regression was used to identify determinants of unfavourable outcome.</p><p><strong>Results: </strong>Of the 881 children included, 52.1% were female and 40.7% were ≤5 years. HIV status was unknown for 36.9% and positive for 10.1% of children. Extrapulmonary TB was found in 34.5% of children. The cumulative incidence of unfavourable outcome was 24.5% (95% CI 21.7% to 27.5%). Loss to follow-up (19.8%) was the most frequent unfavourable outcome, followed by death (4.5%) and treatment failure (0.2%). A decreasing trend in the annual proportion of unfavourable outcomes was observed. Determinants of unfavourable outcome included: residence out of Yaoundé (adjusted OR (aOR) 12.51; 95% CI 1.10 to 5.58; p=0.02), unknown HIV status (aOR 2.10; 95% CI 1.47 to 3.00; p<0.001) and retreatment status (aOR 7.25; 95% CI 1.98 to 29.45; p=0.003).</p><p><strong>Conclusions: </strong>Despite encouraging improvements over time, unfavourable outcomes remain high in paediatric TB. Strengthening HIV testing, follow-up systems and access to care for children in rural areas is essential to sustain and accelerate progress in TB treatment success.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406847/pdf/","citationCount":"0","resultStr":"{\"title\":\"Trends and determinants of unfavourable outcomes in paediatric tuberculosis: insights from a 20-year cohort in Cameroon.\",\"authors\":\"Virginie Poka-Mayap, Reine Charlye Dombu-Guiafaing, Adamou Dodo Balkissou, Laurent-Mireille Endale Mangamba, Alain Kuaban, Abdou Wouliyou Nsounfon, Massongo Massongo, Marie Elisabeth Ngah Komo, Arnaud Laurel Ntyo'o Nkoumou, Eric Walter Pefura-Yone\",\"doi\":\"10.1136/bmjresp-2025-003292\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Tuberculosis (TB) remains a leading cause of childhood morbidity and mortality in resource-limited settings. Despite progress in TB care, unfavourable treatment outcome persists, highlighting the need to identify determinants and address gaps in paediatric TB management. This study aimed to assess treatment outcomes and identify determinants of unfavourable outcomes in children treated for TB at a referral centre in Cameroon.</p><p><strong>Methods: </strong>This retrospective cohort study included children aged <15 years diagnosed with TB and followed at the Jamot Hospital of Yaoundé from 2001 to 2020. Treatment outcome was classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure or loss to follow-up). Sociodemographic and clinical data were recorded. A Poisson regression model was applied to evaluate temporal trends in the annual incidence of unfavourable outcomes. Logistic regression was used to identify determinants of unfavourable outcome.</p><p><strong>Results: </strong>Of the 881 children included, 52.1% were female and 40.7% were ≤5 years. HIV status was unknown for 36.9% and positive for 10.1% of children. Extrapulmonary TB was found in 34.5% of children. The cumulative incidence of unfavourable outcome was 24.5% (95% CI 21.7% to 27.5%). Loss to follow-up (19.8%) was the most frequent unfavourable outcome, followed by death (4.5%) and treatment failure (0.2%). A decreasing trend in the annual proportion of unfavourable outcomes was observed. Determinants of unfavourable outcome included: residence out of Yaoundé (adjusted OR (aOR) 12.51; 95% CI 1.10 to 5.58; p=0.02), unknown HIV status (aOR 2.10; 95% CI 1.47 to 3.00; p<0.001) and retreatment status (aOR 7.25; 95% CI 1.98 to 29.45; p=0.003).</p><p><strong>Conclusions: </strong>Despite encouraging improvements over time, unfavourable outcomes remain high in paediatric TB. 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引用次数: 0
摘要
背景：在资源有限的环境中，结核病（TB）仍然是儿童发病和死亡的主要原因。尽管在结核病治疗方面取得了进展，但不利的治疗结果仍然存在，这突出表明需要确定决定因素并解决儿科结核病管理方面的差距。本研究旨在评估喀麦隆转诊中心治疗结核病儿童的治疗结果并确定不利结果的决定因素。结果：纳入的881名儿童中，女性占52.1%，年龄≤5岁的儿童占40.7%。36.9%的儿童HIV感染状况未知，10.1%的儿童HIV感染状况呈阳性。肺外结核患儿占34.5%。不良结局的累积发生率为24.5% （95% CI 21.7% ~ 27.5%）。失访（19.8%）是最常见的不良结果，其次是死亡（4.5%）和治疗失败（0.2%）。观察到不利结果的年比例呈下降趋势。不利结果的决定因素包括：居住在雅温顿以外(调整OR (aOR) 12.51；95% CI 1.10 ~ 5.58；结论：尽管随着时间的推移有了令人鼓舞的改善，但儿童结核病的不利结局仍然很高。加强农村地区儿童的艾滋病毒检测、后续系统和获得护理对于维持和加速结核病治疗成功方面的进展至关重要。
Trends and determinants of unfavourable outcomes in paediatric tuberculosis: insights from a 20-year cohort in Cameroon.
Background: Tuberculosis (TB) remains a leading cause of childhood morbidity and mortality in resource-limited settings. Despite progress in TB care, unfavourable treatment outcome persists, highlighting the need to identify determinants and address gaps in paediatric TB management. This study aimed to assess treatment outcomes and identify determinants of unfavourable outcomes in children treated for TB at a referral centre in Cameroon.
Methods: This retrospective cohort study included children aged <15 years diagnosed with TB and followed at the Jamot Hospital of Yaoundé from 2001 to 2020. Treatment outcome was classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure or loss to follow-up). Sociodemographic and clinical data were recorded. A Poisson regression model was applied to evaluate temporal trends in the annual incidence of unfavourable outcomes. Logistic regression was used to identify determinants of unfavourable outcome.
Results: Of the 881 children included, 52.1% were female and 40.7% were ≤5 years. HIV status was unknown for 36.9% and positive for 10.1% of children. Extrapulmonary TB was found in 34.5% of children. The cumulative incidence of unfavourable outcome was 24.5% (95% CI 21.7% to 27.5%). Loss to follow-up (19.8%) was the most frequent unfavourable outcome, followed by death (4.5%) and treatment failure (0.2%). A decreasing trend in the annual proportion of unfavourable outcomes was observed. Determinants of unfavourable outcome included: residence out of Yaoundé (adjusted OR (aOR) 12.51; 95% CI 1.10 to 5.58; p=0.02), unknown HIV status (aOR 2.10; 95% CI 1.47 to 3.00; p<0.001) and retreatment status (aOR 7.25; 95% CI 1.98 to 29.45; p=0.003).
Conclusions: Despite encouraging improvements over time, unfavourable outcomes remain high in paediatric TB. Strengthening HIV testing, follow-up systems and access to care for children in rural areas is essential to sustain and accelerate progress in TB treatment success.
期刊介绍：
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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