Survival and predictors of mortality among children co-infected with Tuberculosis and Human Immunodeficiency Virus at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2017. A Retrospective follow-up study

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.