Predictors of mortality among children co-infected with tuberculosis and human immunodeficiency virus in Tigray Region, North Ethiopia: Retrospective follow-up study

Abstract

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection in the human body potentiate each other by weakening the immune system and causing death, if untreated. Tuberculosis is a major cause of morbidity and mortality in children infected with the human immunodeficiency virus. Evidence on survival and predictors of mortality among TB and HIV co-infection in children is limited and not well documented in Ethiopia. This study aimed to evaluate the predictors of mortality among children with TB and HIV co-infected in general hospitals in two zones of the Tigray region, North Ethiopia, from 2008-2018. An institution-based retrospective follow-up study was conducted. Data were collected from medical records using a data extraction checklist and then entered using epi-data manager 4.4.2.1 and then exported to STATA version 14 for analysis. The Cox regression model was used for both bivariate and multivariate analyses. Of a total of 253 children included in the analysis, 38(15%) children have died. The overall mortality rate was 0.17 (95% CI: 0.12, 0.23) per 1000 child-month observation. Underweight at baseline (AHR=7.9 (95% CI: 1.3, 49.3)), IPT non user (AHR=3.7; 95%CI: 1.3-10.8), Poor adherence to ART (AHR = 3.8 (95% CI:1.4, 10.5)), Extrapulmonary tuberculosis (AHR = 2.9 (95% CI: 1.1, 7.6)), advanced WHO-staging(III&IV) (AHR=6.8 (95% CI: 1.9, 24.9)) and hemoglobin level <10 mg/dl during follow-up (AHR 3.75 (95% CI: 1.06, 13.28)) were predictors of increased mortality. In conclusion, the mortality rate of children co-infected with TB and HIV was high. Early diagnosis and treatment of TB among HIV-infected children is needed. The treatment of malnutrition and anemia should be given emphasis. Strengthening the administration of preventive therapy (IPT, CPT) and counseling on adherence to ART drugs were crucial interventions to reduce mortality among children co-infected with TB and HIV. Children who have extra-pulmonary tuberculosis and advanced clinical staging (III and IV) need special consideration during treatment.

Keywords: Predictors of mortality, co-infection with TB and HIV, children, retrospective follow-up study.

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