Conclusion
Our findings indicate the importance of proximal factors (e.g. male gender, sicker children e.g. those hospitalize, medial factors (e.g. caregiver tobacco use) and distal factors (e.g. educational attainment, economic stability, nutritional status) in childhood PTB. Our results underscore important entry points to leverage in future interventions. Current, childhood TB interventions are primarily focused on the continuum of care in terms of prevention, adherence and treatment. While these are critical components in achieving TB prevention, our findings suggest that other entry points include a more holistic family approach such as the impact of distal factors on childhood TB. Future interventions may need to target subgroups of children and families who are elevated risk for TB diagnosis and treatment. Within TB endemic settings, screening for risk factors such as psychological distress or tobacco counseling among caregivers with children who are at high risk for TB or who have TB, as well as provision of social protection programs to bolster economic security may be critical in limiting children’s exposure to TB risk factors.
References
1. World Health Organization. 2019. Global tuberculosis report 2019. Licence: CC BY-NC-SA 3.0 IGO; [accessed 2020 July 27]. https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1
2. World Health Organization. 2017. Global tuberculosis report 2017; [accessed 2020 July 27].https://www.who.int/tb/publications/global_report/gtbr2017_main_text.pdf?ua=1
3. Dodd PJ, Yuen CM, Sismanidis C, Seddon JA, Jenkins HE. 2017. The global burden of tuberculosis mortality in children: A mathematical modelling study. Lancet Glob Health. 5(9):e898-e906. doi: 10.1016/S2214-109X(17)30289-9
4. Lönnroth K, Glaziou P, Weil D, Floyd K, Uplekar M, Raviglione M. 2014. Beyond uhc: Monitoring health and social protection coverage in the context of tuberculosis care and prevention. PLoS Med. 11(9):e1001693.doi: 10.1371/journal.pmed.1001693
5. Graham SM, Sismanidis C, Menzies HJ, Marais BJ, Detjen AK, Black RE. 2014. Importance of tuberculosis control to address child survival. Lancet (London, England). 383(9928):1605-1607.doi: 10.1016/S0140-6736(14)60420-7
6. Egger G. 2014. Beyond obesity and lifestyle: A review of 21st century chronic disease determinants. BioMed Res Int. doi:10.1155/2014/731685
7. Wamani H, Astrøm AN, Peterson S, Tumwine JK, Tylleskär T. 2006. Predictors of poor anthropometric status among children under 2 years of age in rural uganda. Public Health Nutr. 9(3):320-326.doi: 10.1079/phn2006854
8. Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR. 2008. Social determinants of psychological distress in a nationally-representative sample of south african adults. Soc Sci Med (1982). 66(8):1828-1840.doi: 10.1016/j.socscimed.2008.01.025
9. Myer L, Ehrlich RI, Susser ES. 2004. Social epidemiology in south africa. Epidemiol Rev. 26:112-123.doi: 10.1093/epirev/mxh004
10. Marais BJ. 2011. Childhood tuberculosis: Epidemiology and natural history of disease. Indian J Pediatr. 78(3):321-327.doi: 10.1007/s12098-010-0353-1
11. Jaganath D, Mupere E. 2012. Childhood tuberculosis and malnutrition. J Infect Dis. 206(12):1809-1815.doi: 10.1093/infdis/jis608
12. Martin SJ, Sabina EP. 2019. Malnutrition and associated disorders in tuberculosis and its therapy. J Diet Suppl. 16(5):602-610.doi: 10.1080/19390211.2018.1472165
13. Zar HJ, Workman L, Isaacs W, Munro J, Black F, Eley B, Allen V, Boehme CC, Zemanay W, Nicol MP. 2012. Rapid molecular diagnosis of pulmonary tuberculosis in children using nasopharyngeal specimens. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 55(8):1088-1095.doi: 10.1093/cid/cis598
14. Zar HJ, Workman L, Isaacs W, Dheda K, Zemanay W, Nicol MP. 2013. Rapid diagnosis of pulmonary tuberculosis in african children in a primary care setting by use of xpert mtb/rif on respiratory specimens: A prospective study. Lancet Glob Health. 1(2):e97-e104.doi: 10.1016/s2214-109x(13)70036-6
15. Graham SM, Cuevas LE, Jean-Philippe P, Browning R, Casenghi M, Detjen AK, Gnanashanmugam D, Hesseling AC, Kampmann B, Mandalakas A et al. 2015. Clinical case definitions for classification of intrathoracic tuberculosis in children: An update. Clin Infect Dis. 61Suppl 3(Suppl 3):S179-187.doi: 10.1093/cid/civ581
16. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Walters EE, Zaslavsky AM. 2002. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 32(6):959-976.doi: 10.1017/s0033291702006074
17. Andersen LS, Grimsrud A, Myer L, Williams DR, Stein DJ, Seedat S. 2011. The psychometric properties of the k10 and k6 scales in screening for mood and anxiety disorders in the south african stress and health study. Int J Methods Psychiatr Res. 20(4):215-223. doi:10.1002/mpr.351
18. Cohen S, Kamarck T, Mermelstein R. 1983. A global measure of perceived stress. J Health Soc Behav. 24(4):385-396.doi: 10.2307/2136404
19. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. 1990. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess. 55(3-4):610-617.doi: 10.1080/00223891.1990.9674095
20. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA, Project ftACQI. 1998. The audit alcohol consumption questions (audit-c): An effective brief screening test for problem drinking. JAMA Intern Med. 158(16):1789-1795. doi:10.1001/archinte.158.16.1789
21. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. 1991. 86:1119.
22. Reinert DF, Allen JP. 2007. The alcohol use disorders identification test: An update of research findings. Alcoholism: Clinical and Experimental Research. 31(2):185-199.doi: 10.1111/j.1530-0277.2006.00295.x
23. World Health Organziation. 2006. WHO child growth standards who child growth standards. Geneva, Switzerland. ISBN 92 4 154693 X; [accessed 2020 July 27]. https://www.who.int/childgrowth/standards/Technical_report.pdf?ua=1
24. StataCorp. 2017. Stata statistical software: Release 15. College Station, TX: StataCorp LLC.
25. Martinez L, le Roux DM, Barnett W, Stadler A, Nicol MP, Zar HJ. 2018. Tuberculin skin test conversion and primary progressive tuberculosis disease in the first 5 years of life: A birth cohort study from cape town, south africa. Lancet Child Adolesc Health. 2(1):46-55.doi: 10.1016/S2352-4642(17)30149-9
26. Patra J, Bhatia M, Suraweera W, Morris SK, Patra C, Gupta PC, Jha P. 2015. Exposure to second-hand smoke and the risk of tuberculosis in children and adults: A systematic review and meta-analysis of 18 observational studies. PLoS Med. 12(6):e1001835-e1001835.doi: 10.1371/journal.pmed.1001835