Impact of tuberculosis exposure at home on mortality in children under 5 years of age in Guinea-Bissau
- Victor F Gomes1,
- Andreas Andersen1,
- Christian Wejse1,2,
- Ines Oliveira1,
- Fina J Vieira3,
- Luis Carlos Joaquim4,
- Cesaltina S Vieira3,
- Peter Aaby1,
- Per Gustafson5
- 1Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau, and Statens Serum Institut, Copenhagen, Denmark
- 2Department of Infectious Diseases, Aarhus University Hospital, Denmark
- 3Hospital de Pneumologia “Raoul Follereau”, Bissau, Guinea-Bissau
- 4Hospital Nacional Simao Mendes, Bissau, Guinea-Bissau
- 5Infectious Diseases Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Correspondence to Victor Francisco Gomes, Projecto de Saúde de Bandim, Apartado 861, 1004 Bissau Codex, Guiné-Bissau;
- Received 27 April 2010
- Accepted 11 November 2010
- Published Online First 8 December 2010
Objective To assess mortality related to exposure to tuberculosis (TB) at home among children in urban areas of Guinea-Bissau.
Methods In four suburban areas included in the demographic surveillance system of the Bandim Health Project in Bissau, the mortality of children aged <5 years living with an adult with TB was compared with the mortality of children in the general population.
Results Children <5 years of age exposed to an adult with intrathoracic TB had 66% higher mortality than unexposed children (HR 1.66, 95% CI 1.2 to 2.3). The risk was higher for children living in the same family as a TB case (HR 2.15, 95% CI 1.3 to 3.7) than for children living in the same house but not belonging to the same family as the TB case (HR 1.51, 95% CI 1.0 to 2.2). For children whose mother had TB, mortality was increased eightfold (HR 7.82, 95% CI 2.1 to 30). The risk of death was particularly increased from 6 months following exposure (HR 2.16, 95% CI 1.5 to 3.2) and the highest rate of excess mortality was found in children aged 3–4 years. Excess mortality was highest among children with close contact with an adult with sputum-positive pulmonary TB (HR 1.90, 95% CI 1.1 to 3.2), but contact with a sputum-negative case was also associated with increased mortality (HR 1.55, 95% CI 1.0 to 2.3). Adjusting for potential confounding factors did not change these results. The mortality among children living in the same houses 3 years earlier was not increased (HR 0.90, 95% CI 0.6 to 1.3).
Conclusion Intimate family contact with a TB case represents a significant risk factor for child mortality in a low-income country.
Funding The Swedish International Development Cooperation Agency/Department for Research Cooperation (SIDA/SAREC) grant number SWE-2005-111 and the Danish International Development Cooperation (DANIDA).
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.