Trends and determinants of unfavourable outcomes in paediatric tuberculosis: insights from a 20-year cohort in Cameroon.

Background: Tuberculosis (TB) remains a leading cause of childhood morbidity and mortality in resource-limited settings. Despite progress in TB care, unfavourable treatment outcome persists, highlighting the need to identify determinants and address gaps in paediatric TB management. This study aimed to assess treatment outcomes and identify determinants of unfavourable outcomes in children treated for TB at a referral centre in Cameroon.

Methods: This retrospective cohort study included children aged <15 years diagnosed with TB and followed at the Jamot Hospital of Yaoundé from 2001 to 2020. Treatment outcome was classified as favourable (cured or treatment completed) or unfavourable (death, treatment failure or loss to follow-up). Sociodemographic and clinical data were recorded. A Poisson regression model was applied to evaluate temporal trends in the annual incidence of unfavourable outcomes. Logistic regression was used to identify determinants of unfavourable outcome.

Results: Of the 881 children included, 52.1% were female and 40.7% were ≤5 years. HIV status was unknown for 36.9% and positive for 10.1% of children. Extrapulmonary TB was found in 34.5% of children. The cumulative incidence of unfavourable outcome was 24.5% (95% CI 21.7% to 27.5%). Loss to follow-up (19.8%) was the most frequent unfavourable outcome, followed by death (4.5%) and treatment failure (0.2%). A decreasing trend in the annual proportion of unfavourable outcomes was observed. Determinants of unfavourable outcome included: residence out of Yaoundé (adjusted OR (aOR) 12.51; 95% CI 1.10 to 5.58; p=0.02), unknown HIV status (aOR 2.10; 95% CI 1.47 to 3.00; p<0.001) and retreatment status (aOR 7.25; 95% CI 1.98 to 29.45; p=0.003).

Conclusions: Despite encouraging improvements over time, unfavourable outcomes remain high in paediatric TB. Strengthening HIV testing, follow-up systems and access to care for children in rural areas is essential to sustain and accelerate progress in TB treatment success.