Clinico-epidemiological Profile of Pediatric Tuberculosis in a District of Assam

Study design

Secondary data analysis from NIKSHAY portal and Department of Pulmonary Medicine from January 2023 to June 2023.

Site of the study

District of Assam.

Sample size

Taking the prevalence of childhood TB as 3.6% with 20% relative precision and 95% confidence level, the required sample size was 171; calculation was done using nMaster2.0’ (nMaster sample size calculator version 2.0 software, Christian Medical College, Vellore, India).

Study participants

All childhood TB patients registered under NIKSHAY were included. Inclusion criteria are defined as those aged 0–15 years diagnosed with TB at the DTC during the study period. Exclusion criteria were patients with incomplete medical records.

Study variables

Sociodemographic variables such as age and sex and clinical variables such as site of disease and treatment outcome.

Data management and cleaning

All the data were imported in Microsoft Excel 2024 and checked manually. IBM Statistical Package for the Social Sciences software version 21, South Asia, was used for descriptive analysis.

Ethical consideration

Institutional Ethics Committee (IEC) clearance was obtained from the Institutional IEC Committee (H).

Statistics

Descriptive data were presented in the form of numbers, percentages, and diagrams. A comparison of variables for EPTB and PTB outcome was done using the Chi-square test along with the odds ratio.

Demographic characteristics

A total of 241 pediatric TB patients were included. The mean age of children was 11.25 ± 3.8 years and the majority were girls (141 [58.5%] females and 100 [41.5%] males). Tea garden communities were more affected by 66.8% (161), compared to 33.2% (80) from non-tea garden communities [Table 1].

Healthcare seeking behavior of pediatric TB patients

The majority 84.2% (203) were treated in public healthcare facilities, while 38 (15.8%) went to private hospitals. DTC Dibrugarh had the most patients 76 (31.5%), while among rural block primary health centers (PHCs), Lahowal PHC TB unit-IV had 50 (20.7%) patients, Naharani PHC cum first referral unit reported 32 (13.3%) patients, Moran State Dispensary had 30 (12.4%) patients, Tengakhat (TB Unit) had 31 (12.9%) patients, and Khowang block PHC (TB Unit) included 22 (9.1%) patients [Figure 1].

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Figure 1:

Distribution of pediatric tuberculosis (TB) patients in TB units. DTC: District tuberculosis centre, Dibrugarh, BPHC (TU): Block primary health centre (Tuberculosis unit), PHC: Primary health centre, FRU: First referral unit, TU: Tuberculosis Unit

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These findings highlight that the DTC Dibrugarh received more patients while the Khowang Block PHC (TB Unit) received a smaller number of patients.

Clinical presentation of pediatric TB patients

Distribution of TB cases as shown in Table 2 indicates that 205 (85.1%) were classified as new cases, and 5 (2.1%) patients required programmatic management of drug-resistant TB (PMDT). Other previously treated cases accounted for 3.3% (8) and 0.8% (2) patients had recurrent TB. In addition, data for 20 (8.3%) patients were classified as not available (NA). This highlights the predominance of new TB cases, with fewer re-treatment and drug-resistant cases.

Distribution of TB cases by site of disease indicates that 123 (51.0%) patients were diagnosed with PTB, while 102 (42.3%) patients had EPTB. Extrapulmonary was significantly higher in boys whereas in girls, PTB is predominant [Table 3].

Among the extra-pulmonary cases, 20.4% of patients fall into an unspecified category, while lymph node was involved in 10.7% of cases. Abdominal TB was seen in 3.6%, pleural TB in 3.1% of patients, and other forms contributed 7.1%. Tubercular meningitis, a rare but severe form of TB, accounted for 0.4% of cases [Figure 2]. This distribution highlights the significant burden of EPTB, with lymph node involvement being the most common among these.

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Figure 2:

Distribution of tuberculosis cases by site of diseases.

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Treatment outcomes

In Table 4, out of 241 patients, 125 completed their treatment, 16 had been cured, while 13 died. In addition, 5.39% were classified under the “Others” category comprising of non-evaluation of results, loss to follow-up, patient refusal, etc. This distribution indicates that, while the majority of patients had positive treatment outcomes, a considerable number of unclassified outcomes may require further investigation to determine the reasons behind these outcomes.

Treatment outcomes by gender show some notable differences between boys and girls. Girls show a higher cure rate (81% vs. 19%) and treatment completion (59% vs. 41%) compared to boys. Results were NA in 40 (54%) girls and 34 (46%) boys.

According to the India TB Report 2024, the treatment outcome of pediatric TB patients notified in 2022 is shown in Table 5. Table 5 shows the comparison of treatment outcomes of Pediatric TB patients notified in 2022. The finding of the study shows that the treatment outcomes for pediatric TB are categorized into cured, died, lost to follow-up, treatment regimen changed, not evaluated, success rate, treatment failure rate, and other/unclassified. In Dibrugarh, the cured rate is 16 (6.64%) which is lower than Assam’s (13.3%) and India’s (9.9%) cured rate. The death rate in Dibrugarh is 5% out of 241 patients notified which is higher than Assam (2%) and India (1.3%). Dibrugarh district had a lower rate of loss to follow-up (0.4%), compared to Assam (1%) and India (1.9%).

Limitation

While this study on pediatric TB provides important insights, several limitations should be recognized. Although the sample size is adequate, it may not completely represent the wider pediatric population as many cases go unreported, which restricts the generalizability of the findings. Furthermore, the study did not thoroughly investigate factors affecting treatment adherence. Further, community-based studies and implementation research need to be conducted to address the issue.