TY - JOUR
T1 - The child ecosystem and childhood pulmonary tuberculosis: A South African perspective
AU - DeAtley, Teresa
AU - Workman, Lesley
AU - Theron, Grant
AU - Bélard, Sabine
AU - Prins, Margaretha
AU - Bateman, Lindy
AU - Grobusch, Martin P.
AU - Dheda, Keertan
AU - Nicol, Mark P.
AU - Sorsdahl, Katherine
AU - Kuo, Caroline
AU - Stein, Dan J.
AU - Zar, Heather J.
N1 - Funding Information: We gratefully acknowledge the contributions of the NHLS diagnostic microbiology laboratory at Groote Schuur Hospital,?the study laboratory?and clinical staff at Red Cross Children's Hospital and the Division of Medical Microbiology,?and the children and their caregivers. The study was funded by the National Institute of Health, USA (1R01HD058971-01), the Medical Research Council of South Africa, the National Research Foundation (NRF) South Africa, and the European and Developing Countries Clinical Trials Partnership (EDCTP) (TB-NEAT; IP.2009.32040.009). Professor Dheda acknowledges funding from the SA MRC (RFA-EMU-02-2017), EDCTP (TMA-2015SF-1043, TMA-1051-TESAII, TMA-CDF2015), UK Medical Research Council (MR/S03563X/1), and the Wellcome Trust (MR/S027777/1). The writing of this publication was supported by the following National Institute on Drug Abuse (NIDA) predoctoral grant (F31DA049460). Publisher Copyright: © 2021 Wiley Periodicals LLC Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Introduction: This study investigates drivers of childhood pulmonary tuberculosis (PTB) using a childhood ecosystem approach in South Africa. An ecosystem approach toward identifying risk factors for PTB may identify targeted interventions. Methods: Data were collected as part of a prospective cohort study of children presenting at a primary care facility or tertiary hospital with possible TB. Characterization of the childhood ecosystem included proximal, medial, and distal determinants. Proximal determinants included child characteristics that could impact PTB outcomes. Medial determinants included relational factors, such as caregiver health, which might impact interactions with the child. Distal determinants included macro-level determinants of disease, such as socioeconomic status and food insecurity. Children who started on TB treatment were followed for up to 6 months. Multivariate regression models tested independent associations between factors associated with PTB in children. Results: Of 1202 children enrolled, 242 (20%) of children had confirmed PTB, 756 (63%) were started on TB treatment, and 444 (37%) had respiratory conditions other than TB. In univariate analyses, childhood malnutrition and caregiver smoking were associated with treated or confirmed PTB. In multivariate analyses, proximal factors, such as male gender and hospitalization, as well as low socioeconomic status as a distal factor, were associated with PTB. Conclusions: Interventions may need to target subgroups of children and families with elevated proximal, medial, and distal risk factors for PTB. Screening for risk factors, such as caregiver's health, may guide targeting. The provision of social protection programs to bolster economic security may be an important intervention for attenuating childhood exposure to risk factors.
AB - Introduction: This study investigates drivers of childhood pulmonary tuberculosis (PTB) using a childhood ecosystem approach in South Africa. An ecosystem approach toward identifying risk factors for PTB may identify targeted interventions. Methods: Data were collected as part of a prospective cohort study of children presenting at a primary care facility or tertiary hospital with possible TB. Characterization of the childhood ecosystem included proximal, medial, and distal determinants. Proximal determinants included child characteristics that could impact PTB outcomes. Medial determinants included relational factors, such as caregiver health, which might impact interactions with the child. Distal determinants included macro-level determinants of disease, such as socioeconomic status and food insecurity. Children who started on TB treatment were followed for up to 6 months. Multivariate regression models tested independent associations between factors associated with PTB in children. Results: Of 1202 children enrolled, 242 (20%) of children had confirmed PTB, 756 (63%) were started on TB treatment, and 444 (37%) had respiratory conditions other than TB. In univariate analyses, childhood malnutrition and caregiver smoking were associated with treated or confirmed PTB. In multivariate analyses, proximal factors, such as male gender and hospitalization, as well as low socioeconomic status as a distal factor, were associated with PTB. Conclusions: Interventions may need to target subgroups of children and families with elevated proximal, medial, and distal risk factors for PTB. Screening for risk factors, such as caregiver's health, may guide targeting. The provision of social protection programs to bolster economic security may be an important intervention for attenuating childhood exposure to risk factors.
KW - TB determinants
KW - conceptual hierarchical frameworks
UR - http://www.scopus.com/inward/record.url?scp=85103198567&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ppul.25369
DO - https://doi.org/10.1002/ppul.25369
M3 - Article
C2 - 33765350
SN - 8755-6863
VL - 56
SP - 2212
EP - 2222
JO - Pediatric pulmonology
JF - Pediatric pulmonology
IS - 7
ER -