Bonnet Maryline, Nordholm A. C., Ssekyanzi B., Byamukama O., Orikiriza P., Tusabe T., Nyehangane D., Taremwa I. M., Turyashemererwa E., Wobudeya E., Mwanga-Amumpaire J., Marais B., Nampijja D. (2023). Mortality and cause of death in children with presumptive disseminated tuberculosis. Pediatrics, 151 (4), p. [9 p.]. ISSN 0031-4005.
Titre du document
Mortality and cause of death in children with presumptive disseminated tuberculosis
Année de publication
2023
Auteurs
Bonnet Maryline, Nordholm A. C., Ssekyanzi B., Byamukama O., Orikiriza P., Tusabe T., Nyehangane D., Taremwa I. M., Turyashemererwa E., Wobudeya E., Mwanga-Amumpaire J., Marais B., Nampijja D.
Source
Pediatrics, 2023,
151 (4), p. [9 p.] ISSN 0031-4005
BACKGROUND AND OBJECTIVESChildren experience high tuberculosis (TB)-related mortality but causes of death among those with presumptive TB are poorly documented. We describe the mortality, likely causes of death, and associated risk factors among vulnerable children admitted with presumptive TB in rural Uganda. METHODSWe conducted a prospective study of vulnerable children, defined as <2 years of age, HIV-positive, or severely malnourished, with a clinical suspicion of TB. Children were assessed for TB and followed for 24 weeks. TB classification and likely cause of death were assessed by an expert endpoint review committee, including insight gained from minimally invasive autopsies, when possible. RESULTSOf the 219 children included, 157 (71.7%) were <2 years of age, 72 (32.9%) were HIV-positive, and 184 (84.0%) were severely malnourished. Seventy-one (32.4%) were classified as "likely tuberculosis" (15 confirmed and 56 unconfirmed), and 72 (32.9%) died. The median time to death was 12 days. The most frequent causes of death, ascertained for 59 children (81.9%), including 23 cases with autopsy results, were severe pneumonia excluding confirmed TB (23.7%), hypovolemic shock due to diarrhea (20.3%), cardiac failure (13.6%), severe sepsis (13.6%), and confirmed TB (10.2%). Mortality risk factors were confirmed TB (adjusted hazard ratio [aHR] = 2.84 [95% confidence interval (CI): 1.19-6.77]), being HIV-positive (aHR = 2.45 [95% CI: 1.37-4.38]), and severe clinical state on admission (aHR = 2.45 [95% CI: 1.29-4.66]). CONCLUSIONSVulnerable children hospitalized with presumptive TB experienced high mortality. A better understanding of the likely causes of death in this group is important to guide empirical management.
Plan de classement
Santé : généralités [050]
Description Géographique
OUGANDA
Localisation
Fonds IRD [F B010090187]
Identifiant IRD
fdi:010090187
