Laghari, Madeeha
(2018)
Childhood Tuberculosis: Evaluation
Of Clinical Outcomes And Treatment
Compliance In Multicenter Hospitals
Of Sindh, Pakistan.
PhD thesis, Universiti Sains Malaysia.
Abstract
Pakistan is ranked 11 among the high tuberculosis (TB) burden countries where
TB is rated 6th of top 10 causes of mortality. Although, the national guidelines for the
diagnosis and management of TB in children were established in 2007, but little is
known about the management and treatment outcomes of childhood TB in Pakistan.
For this purpose, children treated under Directly Observed Treatment Short course
(DOTS) at (5) multicentre hospitals of Sindh were recruited as cohort in this
observational study. Total 2,167 children were registered during retrospective phase
from 2011 to 2015 and for prospective phase from 1st June 2016 to 30th November
2016, 508 children were enrolled with TB at the study site. During the study period,
childhood TB accounted 12.2% of all TB cases in Hyderabad, Jamshoro and Matiari
districts. In the present study, 12.1% were bacteriologically confirmed sputum smear
positive cases. At the end of intensive phase, 79.3% of patients achieved sputum smear
conversion. Patients who had household contacts with TB and experienced adverse
effects were significantly less likely to achieve sputum conversion and were more
likely to become sputum positive during the treatment. Around 13.2% of patients came
across with adverse effects. In multivariate analysis females and children with previous
treatment were at greater risk to develop adverse effects due to anti-TB drugs. The
overall treatment success rate was recorded as 93%. Rural residents, sputum smear
positive, children with previous treatment, those who had ADRs and household
contacts with TB emerged as predictors for unsuccessful treatment outcomes.
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