Factors associated with disseminated tuberculosis in children

Background. Tuberculosis continues to result in high morbidity and mortality in children from resource-limited settings. Disseminated tuberculosis is a fatal form, with severe clinical symptoms and complications. Hence, it is important to identify the risk factors for the early detection and treatment. Objective. To identify factors associated with disseminated tuberculosis in children. Method. A case-control study including children with tuberculosis below the age of 14, consulted in the period 2010-2017 in the “Dr. Soetomo” Hospital’s Paediatric Outpatient Clinic. The cases were defined as children who were diagnosed with disseminated tuberculosis, miliary tuberculosis and/or tuberculous meningitis. The data were collected using simple random sampling from medical record with such a case and the control ratio was 1:1. The factors analyzed were: age, nutritional status, tuberculosis contact and BCG status, and HIV infection. The tuberculosis contact was defined as a close contact for more than two weeks with a TB patient. Age was divided into more than and below 2 years old, while nutritional status was divided into normal and malnutrition. Chi-square test and logistic regression were used to identify the risk factors. Results. A total of 124 children were evaluated: 62 cases, 62 controls, 31.5% under 2 years of age, 87.9% received BCG immunization. The factors closely associated with severe tuberculosis were tuberculosis contact (OR 7.9; 95% CI; 3.3-18.7; p<0.01) and nutritional status (OR 2.9; 95% CI; 1.1-7.6; p=0.033). Age, BCG status and HIV infection were not significantly related to disseminated tuberculosis. Conclusions. The history of contact and nutritional status are significant factors associated with disseminated tuberculosis in children.