Abstract:
Abstract
Introduction: Tuberculosis (TB) and Human immunodeficiency virus (HIV) co-infections
are the leading cause of death in children globally, which accounts one-third of death
among HIV positive children. However, there are limited studies that assess the survival
status and predictors of mortality among TB/HIV co-infected children in Ethiopia.
Objective: This study aimed to determine the survival rate and predictors of mortality
among TB/HIV co-infected children enrolled at University of Gondar Comprehensive
Specialized Hospital, Northwest Ethiopia from February 2005 to March 2017.
Methods: A retrospective follow-up study was conducted. Data were extracted from the
medical records of the children and entered into EPI-info version 7 then export to STATA
version 12 for analysis. Log-rank test was used to compare the survival experience of two
or more explanatory variables. A Kaplan–Meier curve was used to estimate the survival
time. Bivariabe and multivariable Cox proportional hazards models were fitted to identify
the predictors of time to death, with variables having a p-value<0.05 at 95%CI were
considered as statistically significant.
Result: Among a total of 271 TB/HIV co-infected children 38(14.02%) children were died
during the follow-up period which gives 1167.67 child-years of observations. The overall
mortality rate was 3.27(95%CI; 2.3, 4.5) per 100 child-years. The independent predictors
of time to death were being age 1-5 years as compared with 1 year(AHR=0.3;
95%CI=0.09-0.98)), being anemic (AHR, 2.6;95%CI,1.24, 5.3), CPT non-users (AHR, 4.1;
95%CI; 1.4, 16.75), IPT non-users (AHR, 2.95; 95%CI; 1.16, 7.5), having EPTB (AHR,
2.43; 95%CI; 1.1, 5.3)) and fair or poor adherence (AHR, 3.5; 95%CI; 1.7, 7.5).
Conclusion: Mortality rate among TB/HIV co-infected children at University of Gondar
Comprehensive Specialized Hospital, Northwest Ethiopia was high. Age, extra
pulmonary tuberculosis, anemia, adherence, CPT and IPT were Independent predictors
of mortality. Therefore, those TB/HIV co-infected children, especially those with age less
than one year, extra pulmonary TB and anemia should be closely monitored to increase
their ART adherence as well as they should be provided with CPT and IPT.
Keywords:
TB, HIV, TB/HIV co-infections, survival, mortality, Ethiopia.
