Main Article Content
Introduction: Tuberculosis (TB) is the leading infectious disease killer worldwide, despite significant progress against the disease in recent years. Most cases of TB in children occur in the TB endemic countries but the actual burden of paediatric TB is unknown. With early diagnosis and treatment using the first-line anti-tuberculous drugs, most people who develop the disease can be cured and onward transmission of infection curtailed.
Objective: To determine the pattern and outcome of paediatric tuberculosis managed at a tertiary facility in Sokoto, Nigeria.
Materials and Methods: Records of children managed for TB at the Directly observed treatment short-course (DOTS) clinic over a three-and-a-half-year period were reviewed retrospectively. All children (≤ 15 years) treated for TB over the study period was included. Relevant information was retrieved from the register and analysed accordingly.
Results: 74 children were treated with 33(44.6%) being males, giving a M: F ratio of 1:1.2. Mean (±SD) age was 85.78 (±55.40) months and 34 (45.9%) belonged to the 0.0-5.0-year age group. Seventy-one (95.9%) were new cases and three (4.1%) were relapse. Pulmonary TB (PTB) was seen in 50 (67.6%), more females had PTB than males, which was not significant (χ2=0.4, p=0.52).
Acid fast bacilli (AFB) were positive in only 8 (10.8%) while GeneXpert MTB/RIF sensitivity was detected in 7 (9.2%). Majority 36 (48.6%) were lost to follow up, 30 (40.5%) completed treatment, only 4(5.4%) were cured with no recorded mortality. Successful treatment outcome was low (45.9%).
Conclusion: Treatment outcome using DOTS strategy was poor, far below the WHO benchmark. There is need to improve adherence to DOTs therapy to prevent development of multi drug resistant TB.
Sharma S, Sarin R, Khalid UK, Singha N, Sharma PP, Behera D. The DOTS strategy for treatment of paediatric pulmonology tuberculosis in South Delhi, India. Int J Tuberc Lung Dis. 2007;119(12):74-80.
Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Enarson DA, Beyers N. The spectrum of disease in children treated for tuberculosis in a highly endemic area. Int J Tuberc Lung Dis. 2006;10:732-8.
Marais BJ, Hesseling AC, Gie RP, Schaaf HS, Beyers N. The burden of childhood tuberculosis and the accuracy of community-based surveillance data in an endemic area. Int J Tuberc Lung Dis. 2006;10:259-63.
Marais BJ, Gie RP, Hesseling AC, Simon S, Lombard C, Enarson DA, et al. A refined symptom based approach to diagnose pulmonary tuberculosis in children. Paediatrics. 2006;118:e1350–9.
World Health Organization. Global plan to stop TB, 2006–2015. WHO/HTM/STB/ 2006.35. Geneva, Switzerland: WHO; 2006.
Ogbudebe CL, Izuogu S, Abu CE. Magnitude and treatment outcomes of pulmonary tuberculosis patients in a poor urban slum of Abia State, Nigeria. Int J Mycobacter. 2016;5(2):205-10.
Joseph BN, Sariem CN, Dangiwa DA, David S, Joseph SI, Egoh DZ. Comparative assessment of Directly Observed Treatment Short course (DOTS) for tuberculosis in a primary and a tertiary health centre in Nigeria. J Pharm Bioresources. 2015;12(1):22-9. DOI: 10.4314/jpb.v12:1.4
Erhabor GE, Adewole O, Adisa AO, Olajolo OA. Directly observed treatment short course therapy for tuberculosis- a preliminary report of a three-year experience in a Teaching Hospital. J Natl Med Assoc. 2003;95:1082-8.
Guidance for national tuberculosis programmes on the management of tuberculosis in children 2nd ed. World Health Organization; 2014.
WHO. What is DOTS (Directly Observed Treatment, Short Course). In WHO Tuberculosis. Available:www.searo,who,int (Accessed 9/01/2018)
World Health Organization. Definitions and reporting framework for tuberculosis – 2013 revision 2013. WHO Geneva; 2013b. Accessed 11/11/2017.
Federal Ministry of Health, Nigeria. National Tuberculosis and Leprosy Control Programme: Workers Manual. Revised 5th edition. Abuja: Federal Ministry of Health. 2010;1-119. (Accessed 11/11/2017).
Garba BI, Muhammad AS, Yusuf I, Ibrahim TM, Ahmad MM, Yusuf T et al. Outcome of childhood Tuberculosis at a Specialist Hospital in Gusau, Nigeria. AJMAH. 2018; 11(1):1-5.
Panigatti P, Ratageri VH, Shivannard I, Madhu PK, Shepur TA. Profile and outcome of childhood tuberculosis treatment with DOTS – An observational study. Ind J Paed. 2014;81(1):9-14.
Ramesh H, Shoba A, Manjula VD. Treatment outcomes of childhood tuberculosis with DOTS strategy in Kottayam, Kerala. Ind J Comm Hlth. 2012; 24(4):280-4.
Nandimath VA, Ukarande AR, Chaithra S. Outcome of paediatric DOTS treatment at city tuberculosis centre, Solapur. Ind J Curr Research. 2015;7(08):19683-5.
Bandichhode ST, Nandimath VA. Health profile of paediatric tuberculosis patients on directly observed short course therapy. Ind J Contemp Pediatr. 2016;3(4):1401-4.
Oloyede IP, Johnson OE, David U, Edem B. Pattern of diagnosis and treatment of childhood tuberculosis in a Teaching Hospital in Southern Nigeria. W J Biomed Res. 2019;6(1):29-38.
Paul NI, Alex-Hart BA, Ugwu RO. Tuberculosis in children aged 0-5 years at the University of Port Harcourt (UPTH), Nigeria- How common is HIV in children with tuberculosis. IJTDH. 2019; 36(3):1-8.
Adejumo OA, Daniel OJ, Adebayo BI, Adejumo EN, Jaiyesimi EO, Akang G. Treatment outcomes of childhood tuberculosis in Lagos, Nigeria. J Trop Pediatr. 2016;62(2):131-8.
Daemo MD, Kelbore AG. Treatment outcomes and associated factors of childhood tuberculosis: Treated under DOTS program in health centers of Makelle town, Tigray Regional State, Ethiopia. Central Afr J Pub Hlth. 2016; 2(1):11-7.
Okechukwu AA, Okechukwu OI. Clinical correlate of tuberculosis in HIV co infected children at the University of Abuja Teaching Hospital, Gwagwalada, Nigeria. Niger J Clin Pract. 2011;14(2);206-11.
National Agency for the Control of AIDS Annual Report; 2019. Available:www.naca.gov.ng (Accessed 20/08/2020).
Marais B, Hesseling A, Gie R, Schaaf H, Enarson D, Beyers N. The bacteriologic yield in children with intrathoracic tuberculosis. Clin Infect Dis. 2006;42:e69-e71.
Sunday O, Oladimeji O, Ebenezer F, Akintunde B, Abiola TO, Saliu A, et al. Treatment outcome of tuberculosis patients registered at DOTS centre in Ogbomosho, Southwestern Nigeria: A 4- year retrospective study. Tuberculosis Research Treatment; 2014. DOI: 10.1155/2014201705
Ebuenyi ID, Ikuabe PO, Jumbo J. Treatment outcome of tuberculosis at one year: A single centre’s experience in Niger Delta, Nigeria. IJTDH. 2016;129(1): 1-6.
Kebede ZT, Taye BW, Matebe YH. Childhood tuberculosis; management and treatment outcome among children in Northwest Ethiopia: A cross-sectional study. Pan Afr Med J. 2017,27:25.
Aketi L, Kashongwe Z, Kinsiona C, Fueza SB, Kokolomami J, Bolie G, et al. Childhood tuberculosis in a sub-saharan tertiary facility: epidemiology and factors associated with treatment outcome. PLoS One. 2016;11:e0153914.