Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study
Abstract
:1. Introduction
2. Results
2.1. Tuberculosis Treatment Outcomes
2.2. Predictors of Unsuccessful Treatment Outcomes
3. Discussion
4. Materials and Methods
4.1. Study Design and Settings
4.2. Diagnosis and Treatment of TB in Children at the Study Sites
4.3. Study Population and Data Collection
4.4. Treatment Outcomes
4.5. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Fukunaga, R.; Glaziou, P.; Harris, J.B.; Date, A.; Floyd, K.; Kasaeva, T. Epidemiology of tuberculosis and progress toward meeting global targets—Worldwide, 2019. Morb. Mortal. Wkly. Rep. 2021, 70, 427. [Google Scholar] [CrossRef] [PubMed]
- Awaluddin, S.M.; Ismail, N.; Zakaria, Y.; Yasin, S.M.; Razali, A.; Mutalip, M.H.A.; Lodz, N.A.; Musa, K.I.; Kusnin, F.; Aris, T. Characteristics of paediatric patients with tuberculosis and associated determinants of treatment success in Malaysia using the MyTB version 2.1 database over five years. BMC Public Health 2020, 20, 1903. [Google Scholar] [CrossRef] [PubMed]
- Dodd, P.J.; Yuen, C.M.; Sismanidis, C.; Seddon, J.A.; Jenkins, H.E. The global burden of tuberculosis mortality in children: A mathematical modelling study. Lancet Glob. Health 2017, 5, e898–e906. [Google Scholar] [CrossRef] [Green Version]
- Nelson, L.; Wells, C. Global epidemiology of childhood tuberculosis [Childhood TB]. Int. J. Tuberc. Lung Dis. 2004, 8, 636–647. [Google Scholar]
- An, Y.; Teo, A.K.J.; Huot, C.Y.; Tieng, S.; Khun, K.E.; Pheng, S.H.; Leng, C.; Deng, S.; Song, N.; Nop, S.; et al. Barriers to childhood tuberculosis case detection and management in Cambodia: The perspectives of healthcare providers and caregivers. Res. Sq. 2022. [Google Scholar] [CrossRef]
- Avoi, R.; Liaw, Y.C. Tuberculosis death epidemiology and its associated risk factors in Sabah, Malaysia. Int. J. Environ. Res. Public Health 2021, 18, 9740. [Google Scholar] [CrossRef]
- Liew, S.; Khoo, E.; Ho, B.; Lee, Y.; Mimi, O.; Fazlina, M.; Asmah, R.; Lee, W.K.; Harmy, M.Y.; Chinna, K.; et al. Tuberculosis in Malaysia: Predictors of treatment outcomes in a national registry. Int. J. Tuberc. Lung Dis. 2015, 19, 764–771. [Google Scholar] [CrossRef] [Green Version]
- Sulaiman, S.A.S.; Khan, A.H.; Ahmad, N.; Iqubal, M.S.; Muttalif, A.R.; Hassali, M.A. Impact of diabetes mellitus on treatment outcomes of tuberculosis patients in tertiary care setup. Am. J. Med. Sci. 2013, 345, 321–325. [Google Scholar] [CrossRef] [Green Version]
- Hermosilla, S.; El-Bassel, N.; Aifah, A.; Terlikbayeva, A.; Zhumadilov, Z.; Berikkhanova, K.; Darisheva, M.; Gilbert, L.; Schluger, N.; Galea, S. Tuberculosis report among injection drug users and their partners in Kazakhstan. Public Health 2015, 129, 569–575. [Google Scholar] [CrossRef]
- Chen, X.; He, G.; Wang, S.; Lin, S.; Chen, J.; Zhang, W. Evaluation of whole-genome sequence method to diagnose resistance of 13 anti-tuberculosis drugs and characterize resistance genes in clinical multi-drug resistance Mycobacterium tuberculosis isolates from China. Front. Microbiol. 2019, 10, 1741. [Google Scholar] [CrossRef] [Green Version]
- Ho, C.S.; Feng, P.-J.I.; Narita, M.; Stout, J.E.; Chen, M.; Pascopella, L.; Garfein, R.; Reves, R.; Katz, D.J. Comparison of three tests for latent tuberculosis infection in high-risk people in the USA: An observational cohort study. Lancet Infect. Dis. 2022, 22, 85–96. [Google Scholar] [CrossRef]
- Verma, A.; Kumar, A. Assessment of profile and outcome of childhood tuberculosis treated with dots. Int. J. Acad. Med. Pharm. 2022, 4, 117–119. [Google Scholar]
- Lolekha, R.; Anuwatnonthakate, A.; Nateniyom, S.; Sumnapun, S.; Yamada, N.; Wattanaamornkiat, W.; Sattayawuthipong, W.; Charusuntonsri, P.; Sanguanwongse, N.; Wells, C.D.; et al. Childhood TB epidemiology and treatment outcomes in Thailand: A TB active surveillance network, 2004 to 2006. BMC Infect. Dis. 2008, 8, 94. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pang, J.; Teeter, L.D.; Katz, D.J.; Davidow, A.L.; Miranda, W.; Wall, K.; Ghosh, S.; Stein-Hart, T.; Restrepo, B.I.; Reves, R. Epidemiology of tuberculosis in young children in the United States. Pediatrics 2014, 133, e494–e504. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cho, Y.-H.; Ho, T.-S.; Wang, S.-M.; Shen, C.-F.; Chuang, P.-K.; Liu, C.-C. Childhood tuberculosis in southern Taiwan, with emphasis on central nervous system complications. J. Microbiol. Immunol. Infect. 2014, 47, 503–511. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Awaluddin, S.M.; Ismail, N.; Yasin, S.M.; Zakaria, Y.; Mohamed Zainudin, N.; Kusnin, F.; Yusoff, M.A.S.M.; Razali, A. Parents’ Experiences and Perspectives Toward Tuberculosis Treatment Success Among Children in Malaysia: A Qualitative Study. Front. Public Health 2020, 8, 577407. [Google Scholar] [CrossRef]
- Oeltmann, J.; Chengeta, B.; Mboya, J.; Wells, C.; Kilmarx, P.; Samandari, T.; Nelson, L.J. Reported childhood tuberculosis treatment outcomes, Gaborone and Francistown, Botswana, 1998–2002. Int. J. Tuberc. Lung Dis. 2008, 12, 186–192. [Google Scholar]
- Adejumo, O.A.; Daniel, O.J.; Adebayo, B.I.; Adejumo, E.N.; Jaiyesimi, E.O.; Akang, G.; Awe, A. Treatment outcomes of childhood TB in Lagos, Nigeria. J. Trop. Pediatrics 2016, 62, 131–138. [Google Scholar] [CrossRef] [Green Version]
- Mehra, D.; Kaushik, R.M.; Kaushik, R.; Rawat, J.; Kakkar, R. Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India. Trans. R. Soc. Trop. Med. Hyg. 2013, 107, 558–565. [Google Scholar] [CrossRef]
- Dooley, K.E.; Lahlou, O.; Knudsen, J.; Elmessaoudi, M.D.; Cherkaoui, I.; El Aouad, R. Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco. BMC Public Health 2011, 11, 140. [Google Scholar] [CrossRef] [Green Version]
- Marais, B.; Gie, R.; Schaaf, H.; Hesseling, A.; Enarson, D.; Beyers, N. The spectrum of disease in children treated for tuberculosis in a highly endemic area [Unresolved Issues]. Int. J. Tuberc. Lung Dis. 2006, 10, 732–738. [Google Scholar] [PubMed]
- Ramos, J.M.; Reyes, F.; Tesfamariam, A. Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: A ten-year retrospective study. BMC Public Health 2010, 10, 215. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tsai, K.-S.; Chang, H.-L.; Chien, S.-T.; Chen, K.-L.; Chen, K.-H.; Mai, M.-H.; Chen, K.-T. Childhood tuberculosis: Epidemiology, diagnosis, treatment, and vaccination. Pediatrics Neonatol. 2013, 54, 295–302. [Google Scholar] [CrossRef] [PubMed]
- Marais, B.J.; Raviglione, M.C.; Donald, P.R.; Harries, A.D.; Kritski, A.L.; Graham, S.M.; El-Sadr, W.M.; Harrington, M.; Churchyard, G.; Mwaba, P.; et al. Scale-up of services and research priorities for diagnosis, management, and control of tuberculosis: A call to action. Lancet 2010, 375, 2179–2191. [Google Scholar] [CrossRef]
- Lange, C.; van Leth, F.; Mitnick, C.D.; Dheda, K.; Günther, G. Time to revise WHO-recommended definitions of MDR-TB treatment outcomes. Lancet Respir. Med. 2018, 6, 246–248. [Google Scholar] [CrossRef]
Variable | Mean ± SD | No. (%) |
---|---|---|
Gender | ||
Female | 109 (52.9) | |
Male | 97 (47.1) | |
Age (years) | 8.36 ± 4.20 | |
0–5 | 49 (23.8) | |
6–10 | 88 (42.7) | |
11–14 | 69 (33.5) | |
Weight (kg) | 30.63 ± 10.82 | |
State | ||
Penang | 14 (6.8) | |
Sabah | 142 (68.9) | |
Sarawak | 39 (18.9) | |
Selangor | 11 (5.3) | |
Race | ||
Malay | 40 (19.4) | |
Chinese | 38 (18.4) | |
Indian | 7 (3.4) | |
Sabahan | 70 (34.0) | |
Sarawakian | 19 (9.2) | |
Others | 32 (15.5) | |
Residence | ||
Urban | 106 (51.5) | |
Rural | 100 (48.5) | |
Previous TB treatment | ||
No | 194 (94.2) | |
Yes | 12 (5.8) | |
Site of TB | ||
PTB | 146 (70.9) | |
PTB + EPTB | 14 (6.8) | |
Sputum smear-positive PTB | 80 (50.0) | |
Sputum smear-negative PTB | 80 (50.0) | |
EPTB | 46 (22.3) | |
Tuberculous lymphadenitis | 36 (17.5) | |
Pleural TB | 9 (4.4) | |
CNS TB | 12 (5.8) | |
Abdominal TB | 1 (0.5) | |
Genitourinary TB | 1 (0.5) | |
Miliary TB | 1 (0.5) | |
Comorbidity | ||
No | 180 (87.4) | |
Yes | 26 (12.6) | |
Type of comorbidity | ||
HIV | 8 (3.9) | |
DM | 2 (1.0) | |
Hepatitis | 15 (7.3) | |
Others | 5 (2.4) |
Variable | Treatment Outcomes No. (%) | |||||
---|---|---|---|---|---|---|
Successful | Unsuccessful | |||||
Cured | Completed | Died | Failed | Defaulted | Transfer Out | |
Gender | ||||||
Female | 45 (41.3) | 44 (40.0) | 8 (7.3) | 2 (1.8) | 7 (6.4) | 3 (2.7) |
Male | 42 (43.3) | 47 (48.5) | 5 (5.2) | 1 (1.0) | 2 (2.1) | - |
Age (years) | ||||||
0–4 | 2 (4.3) | 32 (69.6) | 9 (19.6) | - | 2 (4.3) | 1 (2.2) |
4–15 | 85 (53.1) | 59 (36.9) | 4 (2.5) | 3 (1.9) | 1 (0.6) | 2 (1.2) |
Race | ||||||
Malay | 16 (40.0) | 16 (40.0) | 4 (10.0) | 1 (2.5) | 2 (5.0) | 1 (5.0) |
Chinese | 15 (39.5) | 20 (52.6) | 2 (5.3) | - | 1 (2.6) | - |
Indian | 3 (42.9) | 3 (42.9) | - | - | 1 (14.1) | - |
Sabahan | 31 (44.3) | 31 (44.3) | 3 (4.3) | 1 (1.4) | 2 (2.8) | 2 (2.8) |
Sarawakian | 9 (38.9) | 8 (50.0) | - | 1 (5.6) | 1 (5.6) | - |
Others | 15 (46.9) | 11 (34.4) | 4 (12.5) | - | 2 (6.2) | - |
Residence | ||||||
Urban | 41 (38.7) | 51 (48.1) | 9 (8.5) | - | 4 (3.8) | 1 (0.9) |
Rural | 46 (46.0) | 40 (40.0) | 4 (4.0) | 3 (3.0) | 5 (5.0) | 2 (2.0) |
Site of TB | ||||||
Pulmonary TB | 82 (56.2) | 44 (30.1) | 6 (4.1) | 3 (2.1) | 8 (5.5) | 3 (2.0) |
EPTB | - | 39 (84.8) | 7 (15.2) | - | - | - |
PTB + EPTB | 5 (35.7) | 8 (57.1) | - | - | 1 (7.1) | - |
Comorbidity | ||||||
No | 75 (41.7) | 84 (46.7) | 11 (6.1) | 3 (1.7) | 5 (2.8) | 2 (1.1) |
Yes | 12 (46.2) | 7 (26.9) | 2 (7.7) | - | 4 (15.4) | 1 (3.8) |
Number of TB symptoms | ||||||
≤2 | 48 (46.2) | 41 (39.4) | 5 (4.8) | 2 (1.9) | 6 (5.8) | 2 (1.9) |
3–4 | 32 (38.1) | 42 (50.0) | 7 (8.3) | 1 (1.2) | 2 (2.4) | - |
≥5 | 7 (38.9) | 8 (44.4) | 1 (5.6) | - | 1(5.5) | 1 (5.5) |
Variable | Treatment Outcome No. (%) | OR (95% CI) | p-Value | |
---|---|---|---|---|
Unsuccessful | Successful | |||
Gender | ||||
Female | 20 (18.3) | 89 (81.7) | Referent | |
Male | 8 (8.2) | 89 (91.8) | 0.400 (0.167–0.956) | 0.039 |
Age (years) | ||||
0–4 | 12 (26.1) | 34 (73.9) | Referent | |
4–15 | 16 (10.0) | 144 (90.0) | 0.315 (0.136–0.727) | 0.007 |
Race | ||||
Malay | 8 (20.0) | 32 (80.0) | Referent | |
Chinese | 3 (7.9) | 35 (92.1) | 0.343 (0.084–1.406) | 0.137 |
Indian | 1 (14.3) | 6 (85.7) | 0.667 (0.070–6.353) | 0.724 |
Sabahan | 6 (18.8) | 26 (81.2) | 0.923 (0.284–2.999) | 0.894 |
Sarawakian | 2 (10.5) | 17 (89.5) | 0.500 (0.095–2.634) | 0.414 |
Others | 8 (11.4) | 62 (88.6) | 0.516 (0.177–1.503) | 0.225 |
Residence | ||||
Urban | 14 (13.2) | 92 (86.8) | Referent | |
Rural | 14 (14.0) | 86 (86.0) | 1.070 (0.482–2.734) | 0.868 |
Site of TB | ||||
Pulmonary TB | 20 (13.7) | 126 (86.3) | Referent | |
EPTB | 7 (15.2) | 39 (84.8) | 1.131 (0.445–2.874) | 0.796 |
PTB + EPTB | 1 (7.1) | 13 (92.9) | 0.497 (0.060–3.910) | 0.497 |
Comorbidity | ||||
No | 21 (11.7) | 159 (88.3) | Referent | |
Yes | 7 (26.9) | 19 (73.1) | 2.789 (1.048–7.424) | 0.04 |
Number of TB symptoms | ||||
≤2 | 15 (14.4) | 89 (85.6) | Referent | |
3–4 | 10 (11.9) | 74 (88.1) | 0.802 (0.304–1.890) | 0.614 |
≥5 | 3 (16.7) | 15 (83.3) | 1.187 (0.306–4.600) | 0.804 |
Variable | B | SE | OR (95% CI) | p-Value |
---|---|---|---|---|
Male gender | −0.941 | 0.472 | 0.390 (0.155–0.985) | 0.046 |
Age 5–14 years | −1.276 | 0.465 | 0.279 (0.112–0.965) | 0.006 |
Chinese race | −8.93 | 0.752 | 0.410 (0.094–1.789) | 0.235 |
Comorbidity | 0.930 | 0.560 | 2.535 (0.863–7.452) | 0.090 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Ahmad, R.; Syed Sulaiman, S.A.; Muttalif, A.R.; Ahmad, N.; Yaghi, A.R.A.; Goh, K.W.; Ming, L.C.; Ahmed, N.J.; Khan, A.H. Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study. Antibiotics 2022, 11, 1639. https://doi.org/10.3390/antibiotics11111639
Ahmad R, Syed Sulaiman SA, Muttalif AR, Ahmad N, Yaghi ARA, Goh KW, Ming LC, Ahmed NJ, Khan AH. Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study. Antibiotics. 2022; 11(11):1639. https://doi.org/10.3390/antibiotics11111639
Chicago/Turabian StyleAhmad, Rabbiya, Syed Azhar Syed Sulaiman, Abdul Razak Muttalif, Nafees Ahmad, Aseel Rezeq Ali Yaghi, Khang Wen Goh, Long Chiau Ming, Nehad Jaser Ahmed, and Amer Hayat Khan. 2022. "Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study" Antibiotics 11, no. 11: 1639. https://doi.org/10.3390/antibiotics11111639