Epidemiology and Clinical Characteristics of Pediatric Drug-Resistant Tuberculosis in Chongqing, China

To gain insight into the epidemiology of childhood drug resistant tuberculosis (DR-TB) in China that has the second largest burden of TB and the largest number of multidrug resistant (MDR) TB cases in the world, we performed the cross-sectional study to investigate drug resistance of four first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) using Mycobacterium tuberculosis isolates from 196 culture-confirmed pediatric TB cases diagnosed in the Children’s Hospital of Chongqing Medical University, China during 2008–2013. 

Univariate and multivariate logistic regression analyses were performed to assess the associations between patient demographic and clinical characteristics and DR-and MDR-TB, respectively. Twenty-eight percent (56/196) of the study patients exhibited resistance to at least one of the four first-line anti-TB drugs tested. MDR was found in 4.6% (9/196) of the study patients. More than half (5/9, 55.6%) of the MDR cases were from a single county of Chongqing. A significant association was found between being acid-fast bacilli-smear negative and DR-TB (adjusted OR, 2.33; 95% CI, 1.13–4.80) and between having concurrent thoracic-extrathoracic involvement and MDR-TB (adjusted OR, 9.49; 95% CI, 1.05–85.92), respectively. 

The findings of this study indicate that the rate of DR is high among pediatric TB patients in Chongqing and suggest an urgent need for studies to identify MDR transmission hotspots in Chongqing, thereby contributing to the control DR- and MDR-TB epidemics in China. The study also generates new insight into the pathogenesis of DR and MDR M. tuberculosis strains and highlights the importance of studying childhood TB to the goal of global TB control.

Below:  Frequency distribution of drug-resistant patterns observed among all 196 culture-confirmed tuberculosis patients diagnosed in the Children's Hospital of Chongqing Medical University during 2008–2013. INH-isoniazid, RIF-rifampicin, EMB-ethambutol, STR-streptomycin. 

Full article at:   http://goo.gl/OSJUiR

By:  

Qian Guo, Yun Pan, Ruixi Liu, Linlin Xing, Zhe Peng, Chaomin Zhu 
Department of Infectious Diseases, Children’s Hospital of Chongqing Medical University, Chongqing, China

Qian Guo, Yun Pan, Ruixi Liu, Linlin Xing, Zhe Peng, Chaomin Zhu 

Key Laboratory of Child Development and Disorders, Ministry of Education, Chongqing, China

Qian Guo, Yun Pan, Ruixi Liu, Linlin Xing, Zhe Peng, Chaomin Zhu 

Key Laboratory of Pediatrics in Chongqing, Chongqing, China

Zhenhua Yang 

Epidemiology Department, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America

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Interventions to Improve Adherence to Treatment for Pediatric Tuberculosis in Low- & Middle-Income Countries: A Systematic Review & Meta-Analysis

Objective

To assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions.

Methods

We searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle-income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices.

Findings

We included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion.

Conclusion

Various interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries.

Below:  Contextual framework showing factors that may promote or threaten adherence to treatment for paediatric tuberculosis in low- and middle-income countries

Notes: The central circle, which contains the adherence dimensions used by the World Health Organization, is surrounded by the five main categories of relevant interventions. The factors that may promote treatment adherence are shown in green boxes and factors that may threaten treatment adherence are shown in white boxes. Therapeutic alliance refers torelationship-building between providers and patients.

Full article at:   http://goo.gl/Y12TV6

By:  Meaghann S Weaver,a Knut Lönnroth,b Scott C Howard,c Debra L Roter,d and Catherine G Lama

^aSt Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, United States of America (USA).

^bGlobal Tuberculosis Programme, World Health Organization, Geneva, Switzerland.

^cWorld Child Cancer USA, Denver, USA.

^dJohns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Corresponding author.

Correspondence to Catherine G Lam (email: gro.edujts@mal.enirehtac).

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