Predictors of mortality in Ugandan children with TB, 2016–2021
METHODS: We designed a historical cohort study of TB cases at Mulago National Referral Hospital, Kampala; and Fort Portal Regional Referral Hospital, Fort Portal, Uganda, in children aged <15 years from 2016 to 2021. We used Kaplan–Meier models to estimate survival and fit multivariable Cox regression models to determine mortality hazards during TB treatment.
RESULTS: We identified 1,658 children diagnosed with TB from 2016 to 2021. Of 1,623 children with known treatment outcomes, 127/1,623 (7.8%) died during TB treatment, 1,298/1,623 (78.3%) completed treatment, 150/1,623 (9.2%) were lost to follow-up, and two children failed treatment. Using Kaplan–Meier functions, the median time to death was 27 days following treatment initiation. In adjusted Cox models, predictors of mortality included HIV (aHR 1.68, 95% CI 1.01–2.81), moderate malnutrition (aHR 2.22, 95% CI 1.18–4.16), and severe malnutrition (aHR 2.92, 95% CI 1.75–4.87).
CONCLUSION: Mortality was high at an urban and a rural referral hospital among children who initiated TB treatment from 2016 to 2021, with the majority of deaths occurring during the intensive phase of TB treatment. Malnutrition and HIV were significant predictors of death during treatment.
Keywords: HIV; malnutrition; rural; treatment outcomes; urban
Document Type: Research Article
Affiliations: 1: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA 2: Baylor College of Medicine Children’s Foundation-Uganda, Kampala 3: Fort Portal Regional Referral Hospital, Fort Portal, Uganda 4: Directorate of Pediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda 5: Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
Publication date: September 1, 2023
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