Abstract
Background: Drug-resistant tuberculosis (DR-TB), especially multidrug-resistant tuberculosis (MDR-TB) is a public health threat. Little is known about estimates of different profiles and rates of DR-TB among children globally.Methods: We did a systematic review and meta-analysis of observational studies reporting DR-TB among children by searching Embase, PubMed, and Scopus databases from January 1, 2000 to October 1, 2020. Publications reporting more than 60 children with bacteriological confirmed tuberculosis and phenotypical drug susceptibility testing (DST) results were included. Pooled proportions of MDR-TB and sub-analysis by age subgroups, regions, economical levels were performed.Results: We identified 4,063 studies, of which 37 were included. Of 23,652 pediatric TB patients, the proportions of DR-TB, MDR-TB, mono-resistant TB, polydrug resistant TB, extensively drug-resistant TB were 13.59% (1,964/14,453), 3.72% (881/23,652), 6.07% (529/8,719), 1.61% (119/7,361), 0.44% (30/6,763), respectively. The pooled proportion of MDR-TB among 23,652 children of 37 studies was 3.7% (95% CI, 3.5–4.0%). Rate of MDR-TB was much lower in high-income countries (1.8%) than that in lower-middle-income countries (6.3%) and upper-middle-income countries (7.3%). More specifically, the rates of MDR-TB were 1.7% in USA, 1.7% in UK, 2.9% in India, 6.0% in South Africa, 9.8% in China, respectively.Conclusions: The burden of DR-TB remains high in children, and there are potential associations between rates of pediatric MDR-TB and national economical levels. More interventions on child TB cases in low-income countries may be urgently needed in future.
Highlights
It is estimated that nearly 1 million children develop tuberculosis (TB) each year [1]
Few previous studies have focused on drug resistance patterns including mono-resistant tuberculosis (MR-TB), multidrug-resistant tuberculosis (MDR-TB), polydrug resistant tuberculosis (PDR-TB), and extensively drug-resistant tuberculosis (XDR-TB) in children throughout the world, and very little is known about the magnitude of this disease and its drug resistance in children [5,6,7]
In our meta-analysis, the pooled proportion of Multidrug resistance (MDR)-TB among 23,652 children of 37 studies was 3.7%
Summary
It is estimated that nearly 1 million children develop tuberculosis (TB) each year [1]. Most of these children are never diagnosed or treated for their disease, and there were an estimated 208,000 child deaths due to TB globally in 2019 [2]. Drug-resistant TB (DR-TB, referring to any resistance to TB drugs), especially multidrug-resistant TB (MDR-TB, defined as Mycobacterium tuberculosis with resistance to at least isoniazid and rifampicin), is a continuing threat in both children and adults, and more than 30,000 children had MDR-TB [2,3,4]. Little is known about estimates of different profiles and rates of DR-TB among children globally
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