Volume 24, Number 3—March 2018
Prospective Observational Study of Incidence and Preventable Burden of Childhood Tuberculosis, Kenya
||Crude OR for TB (95% CI)||p value||aOR for TB (95% CI)||p value|
|Factor present||Factor absent||Factor present||Factor absent|
|Children <5 y|
|HIV infection†||17||73||112||872||1.8 (1.0–3.2)||0.036||1.3 (0.7–2.4)||0.321|
|Severe malnutrition‡||56||35||413||620||2.4 (1.5–3.7)||<0.001||2.6 (1.6–4.1)||<0.001|
|BCG vaccination scar||82||9||921||112||1.1 (0.5–2.3)||0.779||–|
|Close TB contact
|Children 5–14 y|
|HIV infection†||21||38||47||143||1.7 (0.9–3.2)||0.103||1.5 (0.8–2.9)||0.229|
|Severe malnutrition‡||9||50||43||157||0.7 (0.3–1.4)||0.294||–|
|BCG vaccination scar||48||11||173||27||0.7 (0.3–1.5)||0.327||–|
|Close TB contact
|All children <15 y|
|HIV infection†||38||111||159||1,015||2.2 (1.5–3.3)||<0.001||1.9 (1.2–2.9)||0.003|
|Severe malnutrition‡||65||85||456||777||1.3 (0.9–1.8)||0.130||–|
|BCG vaccination scar||130||20||1,094||139||0.8 (0.5–1.4)||0.455||–|
|Close TB contact||63||87||159||1,074||5.0 (3.4–7.3)||<0.001||5.0 (3.4–7.2)||<0.001|
*aOR, adjusted odds ratio; BCG, bacillus Calmette-Guérin; OR, odds ratio; TB, tuberculosis.
†HIV status was missing for 1/150 (0.7%) cases and 59/1233 (4.8%) controls.
‡Severe malnutrition defined according to World Health Organization guidelines as weight-for-age z-score of <3 or the presence of nutritional edema (42).
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1The following members of the Kilifi Improving Diagnosis and Surveillance of Childhood TB (KIDS TB) Study Group also contributed to patient recruitment, investigation, and management: Victor Bandika, Jay Berkley, Kath Maitland, Susan Morpeth, Daisy Mugo, Robert Musyimi, Agnes Mutiso, John Paul Odhiambo, Monica Toroitich, and Hemed Twahir.
Prospective data on childhood tuberculosis (TB) incidence and case detection rates (CDRs) are scant, and the preventable burden of childhood TB has not been measured in prospective studies. We investigated 2,042 children (<15 years of age) with suspected TB by using enhanced surveillance and linked hospital, demographic, notification, and verbal autopsy data to estimate the incidence, CDR, risk factors, and preventable burden of TB among children in Kenya. Estimated TB incidence was 53 cases/100,000 children/year locally and 95 cases/100,000 children/year nationally. The estimated CDR was 0.20–0.35. Among children <5 years of age, 49% of cases were attributable to a known household contact with TB. This study provides much needed empiric data on TB CDRs in children to inform national and global incidence estimates. Moreover, our findings indicate that nearly half of TB cases in young children might be prevented by implementing existing guidelines for TB contact tracing and chemoprophylaxis.