Pre-treatment loss to follow-up among children with multidrug-resistant tuberculosis in South Africa, 2008–2010

Multidrug-resistant (MDR) TB is more difficult to diagnose and treat compared with drug-susceptible TB. Young children are at greater risk of severe TB disease and death when treatment is delayed compared to adults. We sought to describe characteristics of children (<13 years) diagnosed with MDR...

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Vydáno v:PloS one Ročník 15; číslo 4; s. e0230504
Hlavní autoři: Moore, Brittany K., Erasmus, Linda, Ershova, Julia, Smith, Sarah E., Ndjeka, Norbert, Podewils, Laura J.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States Public Library of Science 07.04.2020
Public Library of Science (PLoS)
Témata:
Age
Children
Comparative analysis
Death
Demographic variables
Disease control
Disease prevention
Diseases
Drug resistance
Health aspects
Health risks
Health services
Health surveillance
Infections
Laboratories
Medical diagnosis
Medical records
Medical treatment
Medicine and Health Sciences
Microbial drug resistance
Multidrug resistance
Multidrug resistant organisms
Patients
People and Places
Pretreatment
Provinces
Public sector
Research and Analysis Methods
Tuberculosis
Variables
South Africa
Atlanta Georgia
Georgia
United States > US
ISSN:1932-6203, 1932-6203
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Shrnutí:Multidrug-resistant (MDR) TB is more difficult to diagnose and treat compared with drug-susceptible TB. Young children are at greater risk of severe TB disease and death when treatment is delayed compared to adults. We sought to describe characteristics of children (<13 years) diagnosed with MDR TB between 2008-2010 in three South African provinces and assess factors associated with pre-treatment loss to follow-up. We matched laboratory and medical records at treatment facilities to identify pre-treatment loss and examined demographic and clinical characteristics for association with loss. Categorical variables were examined for association using Pearson's x2 or Fisher's exact test, employing Bonferroni correction for multiple pairwise comparisons. Between 2008-2010, 156 children were diagnosed with laboratory-confirmed MDR TB. Only 44% (n = 69) were documented as having received treatment. Young children (<2 years) (47/59, 80%), children with extrapulmonary (EP) TB (27/34, 79%), and children diagnosed at general hospitals (60/97, 62%) were most likely to be lost before treatment. Children most vulnerable to death from TB are most likely to be lost before treatment, possibly leading to underestimates of disease burden, case notifications, and poor outcomes among this population. Point-of-care diagnosis and robust follow-up may reduce pre-treatment loss in this population.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0230504