“Time To Tuberculosis Development And Its Predictors Among Children Aged Between 6-59 Months Admitted With Severe Acute Malnutrition At Selected Public Hospitals In Addis Ababa, Ethiopia: A Retrospective Follow Up Study."

Abstract

Background: Severe acute malnutrition and tuberculosis are significant health challenges that disproportionately affect young children, especially in low- and middle-income countries. Children with severe acute malnutrition are at a heightened risk of infectious diseases due to their compromised immune systems, making them especially susceptible to tuberculosis. Tuberculosis in young children is a concern because it often goes undiagnosed or is diagnosed late, leading to severe complications and higher mortality rates. Therefore, this study is to determine the time to develop tuberculosis and its predictors among children aged between 6-59 months admitted with severe acute malnutrition at St Paulo’s hospital millennium medical college and All African Leprosy, tuberculosis rehabilitation Training center Hospital. Objective: To determine time to develop tuberculosis and its predictors among children aged between 6-59 months admitted with severe acute malnutrition at public hospitals, Addis Ababa, Ethiopia. Methods: A retrospective follow-up study was conducted at St. Paulo’s Hospital Millennium Medical College and All African Leprosy, Tuberculosis Rehabilitation Training center Hospitals among 280 6-59 months children. A systematic random-selected sampling technique was used to recruit children between six to fifty nine months with severe acute malnutrition who was on follow-up from January 01, 2020 to December 31, 2024. Data extraction format was used to collect data from the patient’s medical chart. A pre-tested structured data extraction tool was used to collect data from patient’s chart using kobo tool box. Data were exported to Stata version 17 software and cleaned for analysis. The mean and median were used to describe a continuous variable. The Kaplan-Meir curve along with log rank test was used to estimate and compare survival time. Bi variable and multivariable Cox proportional hazard model was used to explore significant variables. Following the Cox proportional hazard regression, model goodness-of-fit was checked by Cox-Snell residuals, and assumptions was checked by using the Shenfield residual test and graphically by using the log minus-log function survival curves. P-value <0.05 was used to declare the significance of association. Result: This study includes 280 children aged between 6-59 months with severe acute malnutrition with a response rate of 100%. Regarding to the status of children, 77(27.5%) of children with severe acute malnutrition have developed tuberculosis, 43 new tuberculosis case from Africa leprosy, tuberculosis, rehabilitation and training Hospital and 34 new tuberculosis case from St Paulo’s hospital millennium medical college and the rest of them, 203(73.5%) were censored. A total of 280 patients were followed and produced 232.87 Person-months of observation. The incidence density rate (IDR) of TB in under 5 children with severe acute malnutrition was 33.06 per 100 (95% CI: 26.46, 41.34) children-months observation. The overall median time was 1.16 months. Cox proportional hazard models were fitted to detect tuberculosis. Multivariable Cox proportional hazard analysis revealed that: having a history of TB contact (AHR = 2.18, 95% CI: 1.17, 4.03, P-value = .014), having baseline pneumonia (AHR = 4.42, 95%CI: 2.12, 9.19, P-value = <0.001), HIV/AIDS (AHR = 2.91, 95% CI: 1.38, 6.14, P-value = 0.005) were statistically significant predictors of tuberculosis development. Conclusion: This study shows that the incidence density rate (IDR) of TB in children aged between 6-59 months with SAM was high. Having history of TB contact, HIV/AIDS and baseline pneumonia were found to be significant predictors of TB development in children aged between 6-59 months with SAM. Thus, based on these findings, health care workers should focus on providing nutritional support to under-five children with SAM, prioritizing regular TB screenings and assessments.