Prevalence and determinants of unsuccessful tuberculosis treatment outcomes among children in Northern Ghana: a retrospective review

Abstract

INTRODUCTION: Tuberculosis (TB) remains a leading cause of childhood morbidity and mortality, yet evidence on treatment outcomes and associated determinants in Northern Ghana remains limited. This study examined the prevalence, trends, and determinants of unsuccessful treatment outcomes among children with TB at Tamale Teaching Hospital from 2016 to 2024. METHODS: A retrospective review of secondary data was conducted among children (< 15 years) diagnosed with TB at Tamale Teaching Hospital from 2016 to 2024. Data were extracted from the National Tuberculosis Programme registers. Treatment outcomes were defined according to WHO guidelines. Modified Poisson regression with robust standard errors was used to examine predictors of unsuccessful treatment outcomes, while logistic regression was performed as a sensitivity analysis. Analyses were conducted using Stata version 16 IC (StataCorp LLC, College Station, TX, USA). RESULTS: Of 1,842 TB cases, 245 were children, of whom 233 had documented treatment outcomes and were included in the analysis. The median age was 5 years (IQR: 2-10), and 58.4% were males. Pulmonary TB accounted for 63.5% of cases, while 13.7% had TB/HIV coinfection. The treatment success rate was 75.5% (176/233), while 24.5% (57/233) experienced unsuccessful outcomes, including 11.2% deaths and 13.3% loss to follow-up, with no cases of treatment failure. In multivariable analysis, children aged < 1 year (aRR: 3.04; 95% CI: 1.13-8.23), those aged 5-9 years (aRR: 3.51; 95% CI: 1.63-7.57), and rural residents (aRR: 1.70; 95% CI: 1.08-2.66) had a significantly higher risk of unsuccessful treatment outcomes. Sensitivity analysis using logistic regression confirmed these findings, and no significant associations were observed with sex, HIV status, type of patient, or disease classification. CONCLUSION: Nearly one in four children experienced unsuccessful TB treatment outcomes, mainly due to death and loss to follow-up. Younger age and rural residence were key predictors of poor treatment outcomes. Strengthening early diagnosis, decentralised care, and targeted adherence support for vulnerable groups is essential to improve outcomes.