Spatial distribution of paediatric tuberculosis and factors associated with adverse treatment outcomes in Ashanti Region, Ghana: a retrospective analysis.
Background: Paediatric tuberculosis (TB) is a major public health concern, contributing significantly to global child morbidity and mortality. In Ghana, there is a scarcity of reports on paediatric TB, and this poses a challenge in effectively monitoring progress in TB control within this age group. This study thus examined the spatial distribution of paediatric TB cases, treatment outcomes, and factors influencing adverse treatment outcomes in the Ashanti Region of Ghana.
Methods: This was a retrospective cross-sectional study of paediatric TB cases registered from 2016 to 2020 in 11 randomly selected districts in the Ashanti Region of Ghana. Data were extracted from each district's health facility TB register into a Microsoft Excel spreadsheet. Statistical analysis was performed using Stata version 15.0. Case notification rates (CNR) and treatment outcomes were examined and compared using ArcMap 10.4. Multivariate logistic regression analysis was used to assess the predictors of adverse treatment outcomes. P-values ≤ 0.05 were considered statistically significant at a 95% Confidence Interval.
Results: A total of 6,180 TB patients were registered for treatment in the 11 selected districts, of which 255 (4.1%) were children. Among the children, the cases were slightly more common among males (52.2%) than females (47.8%). Over the five-year period, a gradually declining trend of CNR for all forms of TB was observed, with an overall CNR of 4.9 cases per 100,000 children. A wide variation of CNR was observed among the districts, ranging from 0.2 to 35.5 cases per 100,000 children. Two hundred and six (80.8%) children were successfully treated, while 49 (19.2%) experienced adverse treatment outcomes, including lost to follow-up 9 (3.5%), deaths 25 (9.8%), and not evaluated 15 (5.9%). Co-infection with HIV (AOR: 2.71; 95% CI: 1.21-6.07, p = 0.015) was a significant predictor of adverse TB treatment outcome.
Conclusions: The overall paediatric TB CNR was low. The treatment success rate fell below the World Health Organization's 90% End TB target, and the case fatality rate is concerning. HIV co-infection contributed to adverse treatment outcomes. Thus, it is recommended that the National Tuberculosis Control Programme (NTP) establish a learning platform where districts with high paediatric TB notification rates share their best practices to encourage others to learn to increase the detection of paediatric TB. Additionally, the NTP should train community health workers to conduct stigma-sensitive integrated home visits for TB/HIV co-infected children to mitigate potential adverse treatment outcomes.