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Free Content Modifiable risk factors associated with tuberculosis disease in children in Pune, India

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SETTING: India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases.

OBJECTIVE: To assess the association between novel modifiable risk factors and TB in Indian children.

DESIGN: Cases were children aged ≤5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged ≤5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (IAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2).

RESULTS: Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03–91.81), household food insecurity (aOR 11.55, 95%CI 3.33–40.15) and IAP exposure (aOR 2.67, 95%CI 1.02–6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38–2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and IAP remained associated with TB.

CONCLUSIONS: Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.
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Keywords: household food insecurity; indoor air pollution; pediatric tuberculosis; vitamin D deficiency

Document Type: Research Article

Affiliations: 1: Johns Hopkins University, Baltimore, Maryland, USA; Maine Medical Center, Portland, Maine, USA 2: Byramji Jeejeebhoy Medical College (BJMC), Pune, India 3: BJMC Clinical Trials Unit, Pune, India 4: Johns Hopkins University, Baltimore, Maryland, USA

Publication date: February 1, 2014

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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