Mortality disparities among children and adolescents with tuberculosis in Tanzania Mainland from January 2023 to December 2023: A retrospective cohort study

TL;DR

This study examines TB mortality in children and adolescents in Tanzania, finding higher death rates among those with HIV co-infection and younger patients.

Contribution

The study provides new insights into TB mortality disparities linked to age, referral sources, and co-infection in children and adolescents in Tanzania.

Findings

TB and HIV co-infection increased mortality risk fivefold compared to non-HIV cases.

Children under 5 years old made up 56.62% of the cohort, highlighting vulnerability in younger age groups.

Community referrals were associated with significantly higher survival probabilities compared to CTC referrals.

Abstract

Every year, over 10 million people worldwide contract tuberculosis (TB). The 2024 World Health Organisation TB global report indicated that 32% of the total deaths were children and adolescents under 15 years old. The scale of TB highlights the urgent need for action to end the global epidemic by 2030. This study aims to evaluate the mortality rate, survival probabilities, and factors associated with mortality among children and adolescents with TB in Tanzania. A retrospective cohort study was conducted from the Tanzania National Tuberculosis and Leprosy Programme data, which included individuals under 15 years old who began TB treatment between 1st January 2023 and 31st December 2023. The last patient’s end-of-follow-up time was on 16th June 2024. The primary outcome of interest in our study was death. We calculated overall and covariate-specific TB mortality rates per 1,000 person-months. The Kaplan-Meier curve was employed to estimate survival probabilities. A total of 10,491 children and adolescents receiving TB treatment were included, nearly half of whom, 5,940 (56.62%), were under age 5 years. A total of 177 (1.69%) died, resulting in a crude mortality rate of 2.86 per 1,000 person-months. Furthermore, TB and HIV co-infection individuals had five times the risk of death (aHR = 5.03, 95% CI = 3.40-7.47, p < 0.001) compared to non-HIV infection. Community referrals were associated with a lower risk of mortality (aHR = 0.54, 95% CI = 0.35-0.84, p = 0.006). We observed significantly lower survival probabilities for patients referred from CTC, with rates of 96.8%, 96.0% and 95.8% at 2, 4, and 6 months, respectively, compared to those referred from the community, which showed higher survival probabilities of 99.5%, 99.3% and 99.2% over the same periods. The findings reveal significant differences in TB mortality in relation to age, referral system and co-infection. Integrating TB services with child healthcare programs and strengthening differentiated service delivery models can improve survival rates. Targeted interventions in high-risk areas are essential to reduce TB mortality.

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