Journal
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
Volume 18, Issue 2, Pages 198-204Publisher
INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
DOI: 10.5588/ijtld.13.0314
Keywords
pediatric tuberculosis; household food insecurity; indoor air pollution; vitamin D deficiency
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Funding
- National Institutes of Child Health Diseases, the US National Institutes of Health [1R03HD0610509 01]
- National Institutes of Allergy and Infectious Diseases, National Institute of Health Clinical Trials Unit, Bethesda, MD, USA [5U01A106977]
- Johns Hopkins Center for Global Health Faculty Grant, Baltimore, MD, USA
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SETTING: India accounts for the largest burden of tuberculosis (TB) worldwide, with 26% of the world's cases. OBJECTIVE: To assess the association between novel modifiable risk factors and TB in Indian children. DESIGN: Cases were children aged <= 5 years with confirmed/probable TB based on World Health Organization definitions (definition 1). Controls were healthy children aged <= 5 years. Logistic regression was performed to estimate the adjusted odds ratio (aOR) of being a TB case given exposure, including indoor air pollution (LAP; exposure to tobacco smoke and/or biomass fuels) and vitamin D deficiency. Cases were re-analyzed according to a new consensus research definition of pediatric TB (definition 2). RESULTS: Sixty cases and 118 controls were enrolled. Both groups had high levels of vitamin D deficiency (55% vs. 50%, P = 0.53). In multivariable analysis, TB was associated with household TB exposure (aOR 25.41, 95%CI 7.03-91.81), household food insecurity (aOR 11.55, 95%CI 3.33-40.15) and TAP exposure (aOR 2.67, 95%CI 1.02-6.97), but not vitamin D deficiency (aOR 1.00, 95%CI 0.38-2.66). Use of definition 2 reduced the number of cases to 25. In multivariate analysis, TB exposure, household food insecurity and TAP remained associated with TB. CONCLUSIONS: Household TB exposure, exposure to TAP and household food insecurity were independently associated with pediatric TB.
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