The child ecosystem and childhood pulmonary tuberculosis: A South African perspective.
The child ecosystem and childhood pulmonary tuberculosis: A South African perspective.
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DOI：
10.1002/ppul.25369
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发表时间：
2021-07
影响因子：
3.1
通讯作者：
Zar HJ
中科院分区：
文献类型：
--
作者：
DeAtley T;Workman L;Theron G;Bélard S;Prins M;Bateman L;Grobusch MP;Dheda K;Nicol MP;Sorsdahl K;Kuo C;Stein DJ;Zar HJ
这项研究使用儿童生态系统方法调查了南非儿童肺结核(PTB)的驱动因素。确定肺结核危险因素的生态系统方法可能确定有针对性的干预措施。收集的数据是前瞻性队列研究的一部分，研究对象是在初级保健机构或三级医院就诊的可能患有结核病的儿童。儿童生态系统的特征包括近端、中端和远端的决定因素。最近的决定因素包括可能影响肺结核预后的儿童特征。中间决定因素包括关系因素，如照顾者健康，这可能会影响与孩子的互动。远端决定因素包括宏观层面的疾病决定因素，如社会经济地位和粮食不安全。对开始接受结核病治疗的儿童进行长达6个月的跟踪调查。多元回归模型检验了儿童肺结核相关因素之间的独立相关性。在1202名登记的儿童中，242名(20%)儿童确诊为肺结核，756名(63%)开始接受结核病治疗，444名(37%)患有结核病以外的呼吸道疾病。在单变量分析中，儿童营养不良和照顾者吸烟与接受治疗或确诊的肺结核有关。在多变量分析中，近端因素，如男性性别和住院，以及较低的社会经济地位作为远端因素，与肺结核有关。干预措施可能需要针对近端、中端和远端肺结核风险因素升高的儿童和家庭亚群。筛查风险因素，如照顾者的健康状况，可能会指导目标。提供社会保护计划以加强经济安全可能是减少儿童暴露在风险因素中的重要干预措施。
This study investigates drivers of childhood pulmonary tuberculosis (PTB) using a childhood ecosystem approach in South Africa. An ecosystem approach toward identifying risk factors for PTB may identify targeted interventions. Data were collected as part of a prospective cohort study of children presenting at a primary care facility or tertiary hospital with possible TB. Characterization of the childhood ecosystem included proximal, medial, and distal determinants. Proximal determinants included child characteristics that could impact PTB outcomes. Medial determinants included relational factors, such as caregiver health, which might impact interactions with the child. Distal determinants included macro-level determinants of disease, such as socioeconomic status and food insecurity. Children who started on TB treatment were followed for up to 6 months. Multivariate regression models tested independent associations between factors associated with PTB in children. Of 1202 children enrolled, 242 (20%) of children had confirmed PTB, 756 (63%) were started on TB treatment, and 444 (37%) had respiratory conditions other than TB. In univariate analyses, childhood malnutrition and caregiver smoking were associated with treated or confirmed PTB. In multivariate analyses, proximal factors, such as male gender and hospitalization, as well as low socioeconomic status as a distal factor, were associated with PTB. Interventions may need to target subgroups of children and families with elevated proximal, medial, and distal risk factors for PTB. Screening for risk factors, such as caregiver’s health, may guide targeting. The provision of social protection programs to bolster economic security may be an important intervention for attenuating childhood exposure to risk factors.
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影响因子：
5
作者：
COHEN, S;KAMARCK, T;MERMELSTEIN, R
通讯作者：
MERMELSTEIN, R
影响因子：
36.4
作者：
Martinez, Leonardo;le Roux, David M.;Zar, Heather J.
通讯作者：
Zar, Heather J.
影响因子：
15.8
作者：
Loennroth, Knut;Glaziou, Philippe;Raviglione, Mario
通讯作者：
Raviglione, Mario
影响因子：
3.4
作者：
ZIMET, GD;POWELL, SS;BERKOFF, KA
通讯作者：
BERKOFF, KA
DOI：
10.1016/s0140-6736(14)60420-7
发表时间：
2014-05-03
期刊：
Lancet (London, England)
影响因子：
--
作者：
Graham SM;Sismanidis C;Menzies HJ;Marais BJ;Detjen AK;Black RE
通讯作者：
Black RE