Prevalence and factors associated with pulmonary tuberculosis among children aged 2 to 59 months presenting with severe pneumonia at Alsabah Children’s Hospital, Juba, South Sudan

Abstract

Background: Tuberculosis (TB) is a major public health problem at a global level. According to the World Health Organization (WHO) in 2018, approximately 10 million people developed TB in 2017, of which 1.0 million (10%) were children. Pediatric TB can present as acute pneumonia especially in endemic settings, which might lead to missed and delayed diagnosis, prolonged hospital stay and increased mortality. South Sudan has high prevalence of TB in the adult population and children usually acquire TB from adults in the community. The high prevalence could be attributed to low socioeconomic conditions, displacement, poverty, damaged and poor health infrastructure as a result of conflict. There is no published information regarding prevalence and factors associated with PTB in children admitted with pneumonia in South Sudan. Objectives: To determine the prevalence and factors associated with pulmonary tuberculosis among children with severe pneumonia at Alsabah Children’s Hospital, Juba, South Sudan. Methods: This was a cross sectional study of 404 Children aged 2 to 59 months presenting at Alsabah Children’s Hospital with severe pneumonia. Data was collected using a pretested questionnaire which captured socio-demographic characteristics, clinical history, and physical and laboratory examination. Sputum examination for mycobacterium tuberculosis was performed to all study participants using X-pert MTB/RIF. Additional investigations included Chest x-ray and blood count. Results: Of the 404 children who were recruited with severe pneumonia, 78 (19.3%) had PTB. Of the 78 patients who had PTB, 13 (16.7%) were bacteriologically confirmed while 65 (83.3%) were clinically diagnosed. The factors that were significantly associated with PTB were; Age above two years [AOR 2.32 (95% CI 1.04-5.17) P= 0.039], positive HIV Status [AOR 24.2 (95% CI 2.88-202.62) P= 0.003], severe acute malnutrition [AOR 15.67 (95% CI 6.68-36.73) P= <0.001], lack of BCG Immunization [AOR 3.09 (95% CI 1.06-9.03 P= 0.038], and contact with a known TB Patient [AOR 55.14 (95% CI 10.12-300.6) P= <0.001]. Conclusion and recommendations: This study concluded that 19.3% which is one in every five children presenting with severe pneumonia at Alsabah Children’s Hospital had PTB. Factors which were significantly associated with PTB in these children were; positive HIV status, severe acute malnutrition, no BCG immunization, those who were above two years of age and those who had history of contact with known TB patient. Therefore screening for PTB should be done in children who present with any of the associated factors to improve on early diagnosis and treatment.