The global tuberculosis (TB) estimate in 2011 was 500,000
cases among children under 15 years representing 5.7 % of all cases
and 64, 000 deaths among HIV negative children representing 6.5 % of the
total deaths. In Uganda, the child TB cases reported in 2012 made up less than
3 % of the total cases while recent modelling estimates it at 15–20 %
of adult cases. Mapping of these cases in Kampala district most especially for
the children under five years would reflect recent transmission in the various
communities in the district. We therefore conducted a retrospective study of
reported child TB cases in Kampala district Uganda for 2009–2010 to provide an
estimate of child TB incidence and map the cases.
This was a retrospective cross-sectional study on data
collected from the health unit TB registers in the five divisions of Kampala
district, Uganda. The data was a starting point in preparation for a TB Vaccine
study in children. The extracted data spanned a period from 1st January 2009 to
31st December 2010. The projected population of children below 15 years
was 637,922 in 2009 and 744,750 in 2010 for Kampala district. We based our
projections on the National Bureau of Statistics most recent census report of
2002 before the study duration while assuming a population growth rate of
3.7 % each year. We captured the data into EPI DATA 3.1 and analysed it
using STATA version 12.
We accessed 15,499 records and analysed 1167 records that
were of children below 15 years old. The child TB cases represented
7.5 % (7.3 in 2009 & 7.6 % in 2010) of all the registered cases
in Kampala district. The females were 47 % and the median age was 4 years
(IQR 1, 10). The percent of children less than 5 years old was 54 %.
The percent of pulmonary TB cases was 89 % (1041/1167) with 15 %
smear positive. The proportion of extra-pulmonary TB cases was 11 %
(126/1167). Among those that tested for HIV, 60 % (359/620) had test
results available with an HIV co-infection rate of 47 % (168/359).
Antiretroviral treatment uptake was 24 % among the co-infected. The
incidence of child TB in Kampala was 56 (95 % CI 50–62) per 100,000 in
2009 and 44 (95 % CI 40–49) per 100,000 in 2010. Most of the TB cases
(60 % (410/685)) in Kampala live in slum areas.
There was a higher child TB incidence of 56 per 100,000 in
2009 compared with 44 per 100,000 in 2010. The percentage of child TB cases was
much higher at 7.5 % of all the reported TB cases than the WHO reported
national average. For the review period, the TB cases clustered in particular
slums in Kampala district.
Below: Distribution of TB types in children in Kampala district, Uganda 2009, 2010 (N = 1167)
Below: Childhood TB incidence by age group and division in Kampala district, Uganda 2009, 2010
Below: Distribution of residence of TB cases residing in Kampala District, Uganda 2009–2010 (N = 685)
By:
1Directorate of Paediatrics & Child health, Mulago National Referral Hospital, Kampala, Uganda
2MU-JHU Research Collaboration, Kampala, Uganda
3TRACK TB Project, Management Sciences for Health, Kampala, Uganda
4Uganda National TB & Leprosy Programme, Kampala, Uganda
5Department of Paediatrics & Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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