Paediatrics (RCH) - Research Publications

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    A mixed-methods evaluation of adherence to preventive treatment among child tuberculosis contacts in Indonesia
    Triasih, R ; Padmawati, RS ; Duke, T ; Robertson, C ; Sawyer, SM ; Graham, SM (INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D), 2016-08)
    BACKGROUND: Tuberculosis (TB) can be prevented using isoniazid preventive therapy (IPT) among child contacts. However, the benefits of IPT depend on adherence to at least 6 months of daily treatment. A greater understanding of the barriers to and facilitators of adherence to IPT in resource-poor settings is required to optimise the benefits. METHODS: We prospectively evaluated adherence to IPT and its associated factors among child contacts (age 0-5 years) eligible for IPT. We undertook in-depth interviews with care givers and a focus group discussion with health care workers, which were thematically analysed to explore barriers to and facilitators of adherence from the perspective of both care givers and health workers. RESULTS: Of 99 eligible children, 49 (49.5%) did not complete 6 months of IPT. Children whose care giver collected their IPT medications from primary health centres were more likely to have incomplete adherence than those who collected them from hospitals (aOR 2.9, 95%CI 1.1-7.8). Thematic analyses revealed major barriers to and facilitators of adherence: regimen-related, care giver-related and health care-related factors, social support and access. Many of these factors are readily modifiable. CONCLUSION: Providing information about IPT and improving accessibility for care givers to receive IPT at the primary health care facility should be priorities to facilitate implementation.
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    Explaining variation in the burden of child and adolescent tuberculosis
    Snow, KJ ; Sawyer, SM ; Denholm, JT ; Graham, SM (European Respiratory Society, 2019-06)
    We read with interest the recent publication by Chen et al regarding the burden of notified tuberculosis (TB) among adolescents and young adults in Taiwan[1]. The authors report that 10-24 year olds constituted only 5.2% of all newly diagnosed TB patients in Taiwan from 2005 to 2016, and that this percentage declined from around 6% in 2005 to around 4% in 2016. They contrast these figures with our estimate that young people constitute 17% of all people developing incident TB globally in 2012[2]. There are several factors that explain this apparently large discrepancy.
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    Tuberculosis among children, adolescents and young adults in the Philippines: a surveillance report
    Snow, K ; Yadav, R ; Denholm, J ; Sawyer, S ; Graham, S (WORLD HEALTH ORGANIZATION, REGIONAL OFFICE WESTERN PACIFIC, 2018)
    The Philippines, a country with a young population, is currently experiencing an intense and persistent tuberculosis epidemic. We analysed patient-based national surveillance data to investigate the epidemiology of reported tuberculosis among children (aged 0-9 years), adolescents (aged 10-19 years) and young adults (aged 20-24 years) to better understand the burden of disease and treatment outcomes in these age groups. Descriptive analyses were performed to assess age-related patterns in notifications and treatment outcomes. Data quality was assessed against international benchmarks at the national and regional levels. Overall, 27.3% of tuberculosis notifications for the Philippines in 2015 pertained to children, adolescents and young adults aged 0-24 years. Treatment outcomes were generally favourable, with 81% of patients being cured or completing treatment. The data quality assessment revealed substantial regional variation in some indicators and suggested potential underdetection of tuberculosis in children aged 0-4 years. Children, adolescents and young adults in the Philippines constitute a substantial proportion of patients in the national tuberculosis surveillance data set. Long-term progress against tuberculosis in the Philippines relies on improving the control of tuberculosis in these key age groups.
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    Incidence and prevalence of bacteriologically confirmed pulmonary tuberculosis among adolescents and young adults: a systematic review
    Snow, KJ ; Nelson, LJ ; Sismanidis, C ; Sawyer, SM ; Graham, SM (CAMBRIDGE UNIV PRESS, 2018-06)
    The burden of tuberculosis (TB) among adolescents and young adults in endemic settings is poorly characterised. This study aimed to review published and unpublished estimates of the incidence and prevalence of bacteriologically confirmed TB among young people aged 10-24 years. We searched PubMed and World Health Organization archives for publications and unpublished data from population-based epidemiologic studies reporting confirmed pulmonary TB among young people, conducted from January 2000 onwards. We identified 27 publications and unpublished data from two national surveys, representing a total of 26 studies in 19 countries. The prevalence of bacteriologically confirmed TB ranged from 45 to 799 per 100 000 in the Asia-Pacific region and from 160 to 462 per 100 000 in African settings. We did not identify any epidemiologic studies of confirmed TB among adolescents living with human immunodeficiency virus (HIV). Many studies were excluded due to absent or inadequately reported age-specific data. Adolescents and young adults living in many endemic settings appear to be at substantial risk of developing active TB. There is a pressing need to improve the routine reporting of age in epidemiologic studies of TB, and to generate high-quality epidemiologic data regarding TB among adolescents living with HIV.
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    The incidence of tuberculosis among adolescents and young adults: a global estimate
    Snow, KJ ; Sismanidis, C ; Denholm, J ; Sawyer, SM ; Graham, SM (EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018-02-01)
    Historical data show that the risk of tuberculosis increases dramatically during adolescence, and young people face unique challenges in terms of case detection and effective treatment. However, little is known about the burden of tuberculosis among young people in the modern era. This study aimed to provide the first estimates of the global and regional incidence of tuberculosis among young people aged 10-24 years.Using the World Health Organization (WHO) database of tuberculosis notifications for 2012, we estimated the burden of tuberculosis among young people by WHO region. Adjustments were made for incomplete age disaggregation and underreporting, using supplementary data from several countries representing diverse tuberculosis epidemics.We estimate that 1.78 million (uncertainty interval (UI) 1.23-3.00 million) young people developed tuberculosis in 2012, accounting for 17% of all new tuberculosis cases globally. Young people in the WHO South East Asian Region (721 000, UI 473 000-1.35 million) and the WHO African Region (534 000, UI 359 000-912 000) experienced the greatest number of tuberculosis episodes.Young people suffer a considerable burden of tuberculosis. Age-specific burden of disease estimation for this age group is complicated by incomplete age disaggregation of tuberculosis data, highlighting the importance of continued surveillance system strengthening.