Modifiable risk factors associated with tuberculosis disease in children in Pune, India
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 (IAP; 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 IAP 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 IAP remained associated with TB.
CONCLUSIONS: Household TB exposure, exposure to IAP and household food insecurity were independently associated with pediatric TB.
Keywords: household food insecurity; indoor air pollution; pediatric tuberculosis; vitamin D deficiency
Document Type: Research Article
Affiliations: 1: Johns Hopkins University, Baltimore, Maryland, USA; Maine Medical Center, Portland, Maine, USA 2: Byramji Jeejeebhoy Medical College (BJMC), Pune, India 3: BJMC Clinical Trials Unit, Pune, India 4: Johns Hopkins University, Baltimore, Maryland, USA
Publication date: 01 February 2014
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