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Volume 24, Number 3—March 2018

Prospective Observational Study of Incidence and Preventable Burden of Childhood Tuberculosis, Kenya

Andrew J. BrentComments to Author , Christopher Nyundo, Joyce Langat, Caroline Mulunda, Joshua Wambua, Evasius Bauni, Joyce Sande, Kate Park, Thomas N. Williams, Charles R.J. Newton, Michael Levin, J. Anthony G. Scott, on behalf of the KIDS TB Study Group
Author affiliations: KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya (A.J. Brent, C. Nyundo, J. Langat, C. Mulunda, J. Wambua, E. Bauni, T.N. Williams, C.R.J. Newton, J.A.G. Scott); Oxford University Hospitals NHS Foundation Trust, Oxford, UK (A.J. Brent, K. Park); University of Oxford, Oxford (A.J. Brent, C.R.J. Newton, J.A.G. Scott); Imperial College London, London, UK (A.J. Brent, M. Levin); Aga Khan University, Nairobi, Kenya (J. Sande); London School of Hygiene and Tropical Medicine, London (J.A.G. Scott)

Main Article

Table 6

Crude and adjusted odds ratios for risk factors associated with confirmed or highly probable TB among children examined at Kilifi County Hospital and Coast Provincial General Hospital, Kenya, August 2009–July 2011*

Age group Cases
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

4.1 (2.6–6.6)
5.1 (3.1–8.3)
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

5.1 (2.6–9.9)
5.2 (2.7–9.8)
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).

Main Article

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Main Article

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.

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