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The Child Ecosystem and Childhood Pulmonary Tuberculosis: A South African Perspective
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  • Teresa DeAtley,
  • Lesley Workman,
  • Grant Theron,
  • Sabine Belard,
  • Margaretha Prins,
  • Lindy Bateman,
  • Martin Grobusch,
  • Keertan Dheda,
  • Mark P Nicol,
  • Katherine Sorsdahl,
  • Caroline Kuo,
  • Dan Stein,
  • Heather Zar
Teresa DeAtley
Brown University
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Lesley Workman
University of Cape Town
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Grant Theron
Stellenbosch University
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Sabine Belard
Amsterdam University Medical Centers
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Margaretha Prins
University of Cape Town
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Lindy Bateman
University of Cape Town
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Martin Grobusch
Amsterdam University Medical Centres
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Keertan Dheda
University of Cape Town
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Mark P Nicol
The University of Western Australia
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Katherine Sorsdahl
University of Cape Town
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Caroline Kuo
Brown University School of Public Health
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Dan Stein
University of Cape Town
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Heather Zar
University of Cape Town
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Abstract

Introduction This study investigates drivers of childhood pulmonary tuberculosis (PTB) using a childhood ecosystem approach in South Africa. An ecosystem approach towards identifying risk factors for PTB may identify new directions for intervention. Methods Data were collected as part of a prospective cohort study of children presenting at a primary care facility or tertiary hospital with suspected TB. Characterization of the childhood ecosystem included proximal, medial and distal determinants. Proximal determinants included child characteristics that could impact PTB outcomes. Medial determinants included relational factors such as caregiver health that might impact interactions with the child. Distal determinants included macro-level determinants of disease such as socioeconomic status and food insecurity. Children started on TB treatment were followed for up to 6 months. Multivariate regression models tested independent associations between factors associated with PTB in children. Results Of 1,738 children enrolled in the study, 242 (20%) of children had confirmed PTB, 756 (63%) were started on TB treatment, and 444 (37%) had respiratory conditions other than TB. In univariate analyses, childhood malnutrition and caregiver smoking were associated with treated or confirmed PTB. In multivariate analyses, proximal factors such as male gender and hospitalization and low socio-economic status as a distal factor were associated with PTB. Conclusions Interventions may need to target subgroups of children and families at elevated risk for PTB. Screening for risk factors such caregiver health may guide targeting, and provision of social protection programs to bolster economic security may be important interventions for attenuating childhood exposure to risk factors.

Peer review status:IN REVISION

27 Jul 2020Submitted to Pediatric Pulmonology
28 Jul 2020Assigned to Editor
28 Jul 2020Submission Checks Completed
04 Aug 2020Reviewer(s) Assigned
19 Aug 2020Review(s) Completed, Editorial Evaluation Pending
26 Aug 2020Editorial Decision: Revise Major