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Original article
Impact of tuberculosis exposure at home on mortality in children under 5 years of age in Guinea-Bissau
  1. Victor F Gomes1,
  2. Andreas Andersen1,
  3. Christian Wejse1,2,
  4. Ines Oliveira1,
  5. Fina J Vieira3,
  6. Luis Carlos Joaquim4,
  7. Cesaltina S Vieira3,
  8. Peter Aaby1,
  9. Per Gustafson5
  1. 1Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau, and Statens Serum Institut, Copenhagen, Denmark
  2. 2Department of Infectious Diseases, Aarhus University Hospital, Denmark
  3. 3Hospital de Pneumologia “Raoul Follereau”, Bissau, Guinea-Bissau
  4. 4Hospital Nacional Simao Mendes, Bissau, Guinea-Bissau
  5. 5Infectious Diseases Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
  1. Correspondence to Victor Francisco Gomes, Projecto de Saúde de Bandim, Apartado 861, 1004 Bissau Codex, Guiné-Bissau; victorfranciscogomes{at}


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.

  • Tuberculosis

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  • 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.