TB a leading cause of death among children worldwide

Tuberculosis ranks among the top 10 causes of death among children around the world, a mathematical modeling study showed.

Researchers wrote that the disease represents a “key omission” from analyses of mortality in children aged younger than 5 years.

“The UN Inter-agency Group on Child Mortality Estimation tracks overall under-5 mortality, and breakdowns by cause of death have been estimated by the study group formerly known as the Child Health Epidemiology Reference Group, most recently in 2016,” Peter J. Dodd, PhD, of the University of Sheffield, UK, and colleagues wrote. “These estimates have been important in assessing progress toward targets, directing public health funding and spending and for advocacy. However, tuberculosis has never been explicitly mentioned in these reports.”

The researchers used a mathematical model to estimate deaths of children aged younger than 5 years in 217 countries and territories. Dodd and colleagues disaggregated WHO pediatric TB estimates by age, as well as treatment status and HIV status, using pediatric TB notification data and pediatric ART estimates.

Worldwide, approximately 239,000 children aged younger than 15 years died from TB in 2015, Dodd and colleagues reported (95% CI, 194,000-298,000). More than three-quarters of these deaths (80%; 95% CI, 132,000-257,000) occurred in children aged younger than 5 years.

Most deaths –more than 70% – occurred in southeast Asia and Africa (n = 182,000; 95% CI, 140,000-239,000), the researchers reported. Seventeen percent (n = 39,000; 95% CI, 23,000-73,000) of children who died had HIV, with 31,000 of those children living in Africa (36%; 95% CI, 19,000-59,000).

The vast majority of children who died (96%; n = 230,000; 95% CI, 185,000-289,000) did not receive treatment for TB, Dodd and colleagues wrote.

“The large mortality burden of undiagnosed pediatric tuberculosis should … not spur hopelessness, but action; these new estimates identify a prime opportunity to address an under-recognized and preventable cause of child deaths,” Emily A. Kendall, MD, assistant professor of medicine at Johns Hopkins University School of Medicine, wrote in an accompanying editorial.  “The full elimination of pediatric tuberculosis mortality will require better diagnostic technology, along with crucial advances in treatment and vaccination. However, in the meantime, more consistent preventive treatment for children exposed to tuberculosis and more persistent assessment of potential pediatric tuberculosis cases can go a long way in reducing the mortality burden.” – by Andy Polhamus

Disclosures: Kendall reports no relevant financial disclosures. The researchers report no relevant financial disclosures.