Abstract
Millions of children are suffering from tuberculosis (TB) worldwide and often end-up with fatal outcome especially in resource-poor settings. Tuberculin skin test (TST) is a conventionally used diagnostic test, less sensitive but highly specific for the diagnosis of clinical TB especially in undernourished children. However, we do not have any data on the role of TST positivity among the children who received nutritional intervention. Our aim was to examine the growth differences between TST-positive and TST-negative undernourished children aged 12 to 18 months who received nutritional intervention prospectively for 90 feeding days. Our further aim was to explore the determinants of TST positivity at enrollment. TB screening as one of the secondary causes of malnutrition was performed on 243 stunted [length for age Z score (LAZ) <-2 standard deviations] or at-risk of stunting (LAZ score between <-1 and -2 standard deviations) children in a community-based intervention study designed to improve their growth parameters. Differences of growth between TST-positives (n = 29) and TST-negatives (n = 214) were compared using paired samples t-test and multivariable linear regression from anthropometric data collected before and after nutritional intervention. Multivariable logistic regression was used to find out possible predictors of TST positivity using baseline sociodemographic data. Of the 243 children screened, 29 (11.9%) were TST-positive and 11 (4.5%) had clinically diagnosed pulmonary TB. Statistically significant improvement of LAZ and weight for age Z-score (WAZ) were observed among the TST-negative participants at the end of intervention period (p = 0.03 for LAZ and p = 0.01 for WAZ). However, we did not find any association between TST status and response to nutritional intervention in our multivariable linear regression models. Our study findings demonstrated a positive impact of nutritional intervention on growth parameters among TST-negative participants.
Highlights
Tuberculosis (TB) mainly affects the lungs with grave consequences unless treated appropriately in time
As the objective of our analysis is different from the main Bangladesh Environmental Enteric Dysfunction (BEED) study, we have calculated the sample size required for this potential analysis
Sample size was calculated using the formula of a descriptive study: n = Z2 p(1-p)/d2 and found at least 163 participants are required for this type of screening program [where, n = required sample size, Z = standard normal variant value for 95% confidence level (1.96), p = expected proportion of the condition (12.4% according to a tuberculin survey conducted in Bangladesh), and d = precision (0.05)]
Summary
Tuberculosis (TB) mainly affects the lungs with grave consequences unless treated appropriately in time. It is one of the leading causes of under-5 child mortality worldwide . Association of TST status with growth in Bangladeshi children under its Global Health Program (Project investment id is OPP1136751). The funding agency had no role in study design, data collection and interpretation, or the decision to submit the manuscript for publication. The funding agency had no role in study design, data collection and interpretation, or the decision to submit the manuscript for publication. https://www. gatesfoundation.org/How-We-Work/Quick-Links/ Grants-Database/Grants/2015/11/OPP1136751
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