The global burden of tuberculosis mortality in children: a mathematical modelling study

Peter J Dodd, Courtney M Yuen, Charalambos Sismanidis, James A Seddon, Helen E Jenkins, Peter J Dodd, Courtney M Yuen, Charalambos Sismanidis, James A Seddon, Helen E Jenkins

Abstract

Background: Tuberculosis in children is increasingly recognised as an important component of the global tuberculosis burden, with an estimated 1 million cases in 2015. Although younger children are vulnerable to severe forms of tuberculosis disease, no age-disaggregated estimates of paediatric tuberculosis mortality exist, and tuberculosis has never been included in official estimates of under-5 child mortality. We aimed to produce a global mortality burden estimate in children using a complementary approach not dependent on vital registration data.

Methods: In this mathematical modelling study, we estimated deaths in children younger than 5 years and those aged 5-14 years for 217 countries and territories using a case-fatality-based approach. We used paediatric tuberculosis notification data and HIV and antiretroviral treatment estimates to disaggregate the WHO paediatric tuberculosis incidence estimates by age, HIV, and treatment status. We then applied systematic review evidence on corresponding case-fatality ratios.

Findings: We estimated that 239 000 (95% uncertainty interval [UI] 194 000-298 000) children younger than 15 years died from tuberculosis worldwide in 2015; 80% (191 000, 95% UI 132 000-257 000) of these deaths were in children younger than 5 years. More than 70% (182 000, 140 000-239 000) of deaths occurred in the WHO southeast Asia and Africa regions. We estimated that 39 000 (17%, 23 000-73 000) paediatric tuberculosis deaths worldwide were in children with HIV infections, with 31 000 (36%, 19 000-59 000) in the WHO Africa region. More than 96% (230 000, 185 000-289 000) of all tuberculosis deaths occurred in children not receiving tuberculosis treatment.

Interpretation: Tuberculosis is a top ten cause of death in children worldwide and a key omission from previous analyses of under-5 mortality. Almost all these deaths occur in children not on tuberculosis treatment, implying substantial scope to reduce this burden.

Funding: UNITAID, National Institutes of Health, and National Institute for Health Research.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Modelling data sources and stages CFRs=Case-fatality ratios.
Figure 2
Figure 2
Mortality rate from tuberculosis for children (A) aged

Figure 3

Number of deaths from tuberculosis…

Figure 3

Number of deaths from tuberculosis in children aged

Figure 3
Number of deaths from tuberculosis in children aged

Figure 4

Mosaic plot with areas showing…

Figure 4

Mosaic plot with areas showing the proportion of tuberculosis deaths in children aged…

Figure 4
Mosaic plot with areas showing the proportion of tuberculosis deaths in children aged
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References
    1. Liu L, Oza S, Hogan D. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–3035. - PMC - PubMed
    1. United Nations Millennium Development Goals and Beyond. 2015. http://www.un.org/millenniumgoals/bkgd.shtml (accessed Jan 23, 2017).
    1. United Nations Transforming our world: the 2030 Agenda for Sustainable Development. 2015. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E (accessed Jan 23, 2017).
    1. WHO . Global tuberculosis report 2015. World Health Organization; Geneva: 2015.
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Figure 3
Figure 3
Number of deaths from tuberculosis in children aged

Figure 4

Mosaic plot with areas showing…

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Figure 4
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  • Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study.
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  • Clinical standards for drug-susceptible TB in children and adolescents.
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  • Pragmatic cluster-randomized trial of home-based preventive treatment for TB in Ethiopia and South Africa (CHIP-TB).
    Malhotra A, Nonyane BAS, Shirey E, Mulder C, Hippner P, Mulatu F, Ratshinanga A, Mitiku P, Cohn S, Conradie G, Chihota V, Chaisson RE, Churchyard GJ, Golub J, Dowdy D, Sohn H, Charalambous S, Bedru A, Salazar-Austin N. Malhotra A, et al. Trials. 2023 Jul 25;24(1):475. doi: 10.1186/s13063-023-07514-7. Trials. 2023. PMID: 37491264 Free PMC article. Clinical Trial.
  • Disseminated Tuberculosis Mimicking as Crohn's Disease in a Paediatric Patient.
    Feenstra E, Driesen Y, Moes N, Jouret N, Vanden Driessche K. Feenstra E, et al. Case Rep Infect Dis. 2023 Jun 29;2023:7312630. doi: 10.1155/2023/7312630. eCollection 2023. Case Rep Infect Dis. 2023. PMID: 37425428 Free PMC article.
References
    1. Liu L, Oza S, Hogan D. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–3035. - PMC - PubMed
    1. United Nations Millennium Development Goals and Beyond. 2015. http://www.un.org/millenniumgoals/bkgd.shtml (accessed Jan 23, 2017).
    1. United Nations Transforming our world: the 2030 Agenda for Sustainable Development. 2015. http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E (accessed Jan 23, 2017).
    1. WHO . Global tuberculosis report 2015. World Health Organization; Geneva: 2015.
    1. WHO . Global tuberculosis report 2016. World Health Organization; Geneva: 2016.
Show all 27 references
Publication types
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 4
Figure 4
Mosaic plot with areas showing the proportion of tuberculosis deaths in children aged

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