Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study
Issued Date
2022-12-01
Resource Type
ISSN
00359203
eISSN
18783503
Scopus ID
2-s2.0-85143380040
Pubmed ID
35902999
Journal Title
Transactions of the Royal Society of Tropical Medicine and Hygiene
Volume
116
Issue
12
Start Page
1181
End Page
1190
Rights Holder(s)
SCOPUS
Bibliographic Citation
Transactions of the Royal Society of Tropical Medicine and Hygiene Vol.116 No.12 (2022) , 1181-1190
Suggested Citation
Rahimi B.A., Niazi N., Rahimi A.F., Faizee M.I., Khan M.S., Taylor W.R. Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study. Transactions of the Royal Society of Tropical Medicine and Hygiene Vol.116 No.12 (2022) , 1181-1190. 1190. doi:10.1093/trstmh/trac066 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85204
Title
Treatment outcomes and risk factors of death in childhood tuberculous meningitis in Kandahar, Afghanistan: a prospective observational cohort study
Other Contributor(s)
Abstract
Background: Tuberculous meningitis (TBM) is the most severe form of TB. We prospectively documented the treatment outcomes and the risk factors for death in children with TBM from Kandahar, Afghanistan. Methods: This prospective observational cohort study was conducted from February 2017 to January 2020 in hospitalised TBM children. All the patients were prospectively followed up for 12 mo. Data were analysed by using descriptive statistics, χ2 and multivariate logistic regression. Results: A total of 818 TBM hospitalised patients with median age 4.8 (0.8-14.5) y were recruited. Females accounted for 60.9% (498/818). Upon admission 53.9% (n=441) and 15.2% (n=124) had TBM stages II and III, respectively, and 23.2% (n=190) had focal neurological signs. The case fatality rate was 20.2% (160/794) and 30.6% (243/794) survived with neurological sequelae. Independent risk factors for death were being unvaccinated for BCG (adjusted OR [AOR] 3.8, 95% CI 1.8 to 8.1), not receiving dexamethasone (AOR 2.5, 95% CI 1.5 to 4.2), being male (AOR 2.3, 95% CI 1.5 to 3.6), history of recent weight loss (AOR 2.2, 95% CI 1.3 to 3.9) and having stage III TBM (AOR 2.0, 95% CI 1.2 to 3.3). Conclusions: TBM continues to cause high morbidity and mortality in Afghan children. Strategies to reduce mortality should emphasise early diagnosis and treatment, routine use of dexamethasone and increased BCG vaccination.