• 1.

    World Health Organization, 2017. Global Tuberculosis Report 2017. Geneva, Switzerland: WHO. Available at: http://www.who.int/tb/publications/global_report/en/. Accessed January 6, 2018.

  • 2.

    Mandalakas AM, Starke JR, 2005. Current concepts of childhood tuberculosis. Semin Pediatr Infect Dis 16: 93104.

  • 3.

    Acosta CD, Rusovich V, Harries AD, Ahmedov S, van den Boom M, Dara M, 2014. A new roadmap for childhood tuberculosis. Lancet Glob Health 2: e15e17.

  • 4.

    Starke JR, Cruz AT, 2014. The global nature of childhood tuberculosis. Pediatrics 133: e725e727.

  • 5.

    Cruz AT, Starke JR, 2010. Pediatric tuberculosis. Pediatr Rev 31: 1325.

  • 6.

    CDC, 2007. Reported Tuberculosis in the United States, 2013. Atlanta, GA: U.S. Department of Health and Human Services, CDC.

  • 7.

    Rekha B, Swaminathan S, 2007. Childhood tuberculosis—global epidemiology and the impact of HIV. Paediatr Respir Rev 8: 99106.

  • 8.

    Rylance J, Mchugh G, Metcalfe J, Mujuru H, Nathoo K, Wilmore S, Rowland-Jones S, Majonga E, Kranzer K, Ferrand R, 2016. Chronic lung disease in HIV-infected children established on antiretroviral therapy. AIDS 30: 27952803.

    • Search Google Scholar
    • Export Citation
  • 9.

    World Health Organization, 2013. Systematic Screening for Active Tuberculosis. Available at: http://www.who.int/tb/publications/Final_TB_Screening_guidelines.pdf. Accessed October 10, 2017.

  • 10.

    World Health Organization, 2017. SDG 3: Ensure Healthy Lives and Promote Wellbeing for All at All Ages. Available at: http://www.who.int/sdg/targets/en/. Accessed February 10, 2018.

  • 11.

    Jenkins HE, Yuen CM, Rodriguez CA, Nathavitharana RR, McLaughlin MM, Donald P, Marais BJ, Becerra MC, 2017. Mortality in children diagnosed with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 17: 285295.

    • Search Google Scholar
    • Export Citation
  • 12.

    Ferrand RA, Luethy R, Bwakura F, Mujuru H, Miller RF, Corbett EL, 2007. HIV infection presenting in older children and adolescents: a case series from Harare, Zimbabwe. Clin Infect Dis 44: 874878.

    • Search Google Scholar
    • Export Citation
  • 13.

    United Nations and Department of Economic and Social Affairs, 2005. Demographic Yearbook 2015: Estimates of Population and Its Percentage Distribution, by Age and Sex and Sex Ratio for All Ages for the World, Major Areas and Regions: 2015. United Nations Statistics Division. Available at: https://unstats.un.org/unsd/demographic/products/dyb/dyb2015.htm. Accessed May 4, 2017.

  • 14.

    Oliwa JN, Karumbi JM, Marais BJ, Madhi SA, Graham SM, 2015. Tuberculosis as a cause or comorbidity of childhood pneumonia in tuberculosis-endemic areas: a systematic review. Lancet Respir Med 3: 235243.

    • Search Google Scholar
    • Export Citation
  • 15.

    López Ávalos GG, Prado Montes De Oca E, 2012. Classic and new diagnostic approaches to childhood tuberculosis. J Trop Med 2012: 818219.

  • 16.

    Wiseman CA, Gie RP, Starke JR, Schaaf HS, Donald PR, Cotton MF, Hesseling AC, 2012. A proposed comprehensive classification of tuberculosis disease severity in children. Pediatr Infect Dis J 31: 347352.

    • Search Google Scholar
    • Export Citation
  • 17.

    Yang Z, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, Cave MD, Bates JH, 2004. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis 38: 199205.

    • Search Google Scholar
    • Export Citation
  • 18.

    Kunkel A, Abel zur Wiesch P, Nathavitharana RR, Marx FM, Jenkins HE, Cohen T, 2016. Smear positivity in paediatric and adult tuberculosis: systematic review and meta-analysis. BMC Infect Dis 16: 282.

    • Search Google Scholar
    • Export Citation
  • 19.

    van Rie A, Beyers N, Gie RP, Kunneke M, Zietsman L, Donald PR, 1999. Childhood tuberculosis in an urban population in South Africa: burden and risk factor. Arch Dis Child 80: 433437.

    • Search Google Scholar
    • Export Citation
  • 20.

    Schaaf H, de Villiers G, Donald P, 2000. Clinical insights into the interaction of childhood tuberculosis and HIV in the western Cape. South Afr J HIV Med 7: 3335.

    • Search Google Scholar
    • Export Citation
  • 21.

    Wobudeya E, Lukoye D, Lubega IR, Mugabe F, Sekadde M, Musoke P, 2015. Epidemiology of tuberculosis in children in Kampala district, Uganda, 2009–2010; a retrospective cross-sectional study. BMC Public Health 15: 967.

    • Search Google Scholar
    • Export Citation
  • 22.

    Kapata N, Chanda-Kapata P, O’Grady J, Bates M, Mwaba P, Janssen S, Marais B, Cobelens F, Grobusch M, Zumla A, 2013. Trends in childhood tuberculosis in Zambia: a situation analysis. J Trop Pediatr 59: 134139.

    • Search Google Scholar
    • Export Citation
  • 23.

    Neyrolles O, Quintana-Murci L, 2009. Sexual inequality in tuberculosis. PLoS Med 6: e1000199.

  • 24.

    Holmes CB, Hausler H, Nunn P, 1998. A review of sex differences in the epidemiology of tuberculosis. Int J Tuberc Lung Dis 2: 96104.

  • 25.

    Zimbabwe National Tuberculosis Control Programme, 2010. National TB Guidelines, 4th Edition. Harare, Zimbabwe: Ministry of Health and Child Welfare.

  • 26.

    Cotton MF, Schaaf HS, Hesseling AC, Madhi SA, 2004. HIV and childhood tuberculosis: the way forward. Int J Tuberc Lung Dis 8: 675682.

  • 27.

    Carlucci JG International Epidemiology Databases to Evaluate AIDS (IeDEA) Network, 2017. Tuberculosis treatment outcomes among HIV/TB-coinfected children in the international epidemiology databases to evaluate AIDS (IeDEA) network. J Acquir Immune Defic Syndr 75: 156163.

    • Search Google Scholar
    • Export Citation
  • 28.

    Buzdugan R, McCoy SI, Webb K, Mushavi A, Mahomva A, Padian NS, Cowan FM, 2015. Facility-based delivery in the context of Zimbabwe’s HIV epidemic—missed opportunities for improving engagement with care: a community-based serosurvey. BMC Pregnancy Childbirth 15: 338.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Characterizing Pediatric Tuberculosis with and without Human Immunodeficiency Virus Coinfection in Harare, Zimbabwe

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  • 1 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;
  • 2 Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe;
  • 3 Medical School, University of Michigan, Ann Arbor, Michigan;
  • 4 Department of Paediatrics, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe

Pediatric tuberculosis (TB) represents a major barrier to reducing global TB mortality, especially in countries confronting dual TB and human immunodeficiency virus (HIV) epidemics. Our study aimed to characterize pediatric TB epidemiology in the high-burden setting of Harare, Zimbabwe, both to fill the current knowledge gap around the epidemiology of pediatric TB and to indicate areas for future research and interventions. We analyzed de-identified data of 1,051 pediatric TB cases (0–14 years) found among a total of 11,607 TB cases reported in Harare, Zimbabwe, during 2011–2012. We performed Pearson’s χ2 test and multivariate logistic regression analysis to characterize pediatric TB and to assess predictors of HIV coinfection. Pediatric TB cases accounted for 9.1% of all TB cases reported during 2011–2012. Approximately 50% of pediatric TB cases were children younger than 5 years. Almost 60% of the under-5 age group were male, whereas almost 60% of the 10–14 age group were female. The overall HIV coinfection rate was 58.3%. Odds for HIV coinfection was higher for the 5–9 age group (adjusted odds ratio [AOR]: 2.77, 95% confidence interval [CI]: 1.97–3.94), the 10–14 group (AOR: 3.57, 95% CI: 2.52–5.11), retreatment cases (AOR: 6.17, 95% CI: 2.13, 26.16), and pulmonary TB cases (AOR: 2.39, 95% CI: 1.52, 3.75). In conclusion, our study generated evidence that pediatric TB, compounded by HIV coinfection, significantly impacts children in high-burden settings. The findings of our study indicate a critical need for targeted interventions.

Author Notes

Address correspondence to Zhenhua Yang, Epidemiology Department, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail: zhenhua@umich.edu

Authors’ addresses: Michelle Earley, The Biostatistics Center, The George Washington University, Rockville, MD, E-mail: mearley@bsc.gwu.edu. Joconiah Chirenda, Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, E-mail: joconiahc@gmail.com. Alexandra Highet, Medical School, University of Michigan, Ann Arbor, MI, E-mail: ahighet@med.umich.edu. Hilda A. Mujuru, Department of Pediatrics, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe, E-mail: hmujuru@mweb.co.zw. Zhenhua Yang, Epidemiology Department, School of Public Health, University of Michigan, Ann Arbor, MI, E-mail: zhenhua@umich.edu.

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