Importance of tuberculosis control to address child survival.
Importance of tuberculosis control to address child survival.
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DOI：
10.1016/s0140-6736(14)60420-7
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发表时间：
2014-05-03
期刊：
影响因子：
--
通讯作者：
Black RE
中科院分区：
文献类型：
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作者：
Graham SM;Sismanidis C;Menzies HJ;Marais BJ;Detjen AK;Black RE
在儿童死亡率高的国家，结核病通常影响幼儿（< 5岁）。1控制结核病的全球公共卫生重点传统上旨在通过早期发现病例和有效治疗传染性最强的病例来减少传播。幼儿历来被排除在这一重点之外，因为据信他们对结核病传播的贡献很小。在过去十年中，高负担环境下的国家结核病规划更加重视儿童结核病的挑战。2012年，世界防治结核病日首次以儿童为重点。随着世卫组织全球结核病规划署雄心勃勃的2015年后结核病控制战略寻求让包括孕产妇和儿童保健在内的整个卫生部门参与进来，这种关注可能会进一步增加。在千年发展目标框架内，结核病控制及其相关具体目标是在千年发展目标6内制定的，但也与千年发展目标4和5（儿童和孕产妇死亡率）以及千年发展目标1（营养不良）相关。改善儿童存活率是一项重大的全球卫生优先事项，但结核病在这方面并不被视为重要。然而，我们认为，在今后十年中，结核病与儿童生存的关系将变得越来越明显，特别是在结核病控制仍然困难和结核分枝杆菌传播率居高不下的国家。人们日益认识到结核病对儿童生存的重要性和挑战。3《2012年世卫组织全球结核病报告》4是提供儿童结核病负担全球估计数的该报告的第一版。人们普遍认识到，在提供儿童结核病准确估计数方面存在困难，包括病例发现、诊断准确性以及记录和报告做法不佳等挑战。人口动态登记数据，其中死亡原因根据《国际疾病分类》的两个最新修订版进行编码（ICD;潜在死亡原因：ICD-10 A15-A19，相当于ICD-9：010-018），用于对未感染艾滋病毒的儿童中结核病造成的儿童死亡率进行全球估计，2012年最新估计有74000人死亡。5由于这些死亡仅占2012年全球儿童死亡估计总数的1%左右，因此结核病不被视为儿童死亡的主要原因。然而，74 000名儿童死于结核病的估计数存在重要的局限性。第一，结核病也是感染艾滋病毒儿童死亡的一个重要原因，6但艾滋病毒被登记为这些死亡的根本原因，结核病被登记为促成原因。由于三分之一拥有人口动态登记系统的国家只向世卫组织报告了死亡的根本原因，而不是促成原因，因此人口动态登记数据不能用于估计艾滋病毒感染者死于结核病的人数。此外，全球仅有3%的儿童死亡病例有生命登记数据，而且大多数结核病流行国家都没有。5. 5岁以下儿童因结核病死亡的风险最高。7，8然而，准确描述幼儿结核病相关死亡可能具有挑战性，因为结核病的临床特征并不特异。幼儿结核病通常是一种临床诊断，未得到微生物学证实，特别是在资源稀缺的结核病流行地区。因此，估计结核病对幼儿死亡的贡献已归因于...
Tuberculosis commonly affects young children (< 5 years) in countries that have high rates of child mortality. 1 The global public health focus to control tuberculosis has traditionally aimed to reduce transmission through early case-finding and effective treatment of the most infectious cases. Young children have historically been excluded from this focus, since their contribution to tuberculosis transmission is believed to be small. In the past decade, national tuberculosis programmes in highburden settings have given increased attention to the challenges of childhood tuberculosis. 2 In 2012, World TB Day focused on children for the first time. This attention is likely to increase further as the WHO Global Tuberculosis Programme’s ambitious post-2015 tuberculosis control strategy seeks to engage the entire health sector, including maternal and child health. Within the Millennium Developmental Goal (MDG) framework, tuberculosis control and its related targets are framed within MDG 6, and yet are also relevant to MDGs 4 and 5 (child and maternal mortality) and MDG 1 (undernutrition). Improvement of child survival is a major global health priority but tuberculosis is not regarded as important in that context. However, we believe that the relevance of tuberculosis to child survival will become increasingly apparent over the next decade, especially in countries where tuberculosis control remains difficult and high rates of Mycobacterium tuberculosis transmission are sustained. Recognition of the relevance and challenges of tuberculosis to child survival is growing. 3 The 2012 WHO Global Tuberculosis Report4 was the first edition of this report to provide global estimates of the burden of childhood tuberculosis. The difficulties in provision of accurate estimates of childhood tuberculosis are widely acknowledged and include challenges of case detection, diagnostic accuracy, and poor recording and reporting practices. Vital registration data, in which causes of death are coded according to the two latest revisions of the International Classification of Diseases (ICD; underlying cause of death: ICD-10 A15–A19, equivalent to ICD-9: 010–018), were used to produce a global estimate of childhood mortality attributed to tuberculosis in children not infected with HIV, with the most recent estimate of 74 000 deaths in 2012. 5 Because these deaths represent only about 1% of the estimated total deaths in children globally in 2012, tuberculosis is not regarded as a major contributor to child mortality. However, there are important limitations to the estimate of 74 000 child deaths from tuberculosis. First, tuberculosis is also an important cause of death in children living with HIV, 6 but for these deaths HIV is registered as the underlying cause and tuberculosis as a contributory cause. Since a third of countries with vital registration systems report only the underlying causes of death and not contributory causes to WHO, vital registration data cannot be used to estimate the number of tuberculosis deaths in people living with HIV. Further, vital registration data are available for only 3% of global child deaths and are not available in most tuberculosisendemic countries. 5The risk of death due to tuberculosis in children is highest for those younger than 5 years. 7, 8 However, accurate characterisation of tuberculosis-related deaths in young children can be challenging because the clinical features of tuberculosis are not specific. Tuberculosis in young children is usually a clinical diagnosis that is not confirmed microbiologically, especially in tuberculosisendemic areas with scarce resources. Therefore, estimation of the contribution of tuberculosis to deaths in young children that have been attributed …