Mortality and associated factors among children with the double burden of human immunodeficiency virus and tuberculosis in African countries: a systematic review and meta-analysis
Notice bibliographique
Résumé
INTRODUCTION: The dual burden of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) in children is leading to significant mortality. Although primary studies have reported wide ranges of mortality rates among HIV-TB co-infected children in various African countries, a comprehensive estimate of mortality and associated factors is lacking. Therefore, this study aims to assess mortality and associated factors among HIV-TB co-infected children in Africa, which will address existing inconsistencies and assist the development of preventive strategies. METHODS: A systematic search was conducted to retrieve studies from PubMed, Scopus, Embase, Google Scholar, ScienceDirect, HINARI, and other relevant sources. All studies conducted in Africa on mortality among HIV-TB co-infected children were included. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. A random-effects model was used to estimate the mortality rate, and the Higgins heterogeneity statistic (I²) was applied to assess variation between studies. Sub-group analysis and meta-regression were conducted to detect the source of heterogeneity, while the quality of the studies was assessed using the Newcastle Ottawa Scale (NOS). Publication bias was checked with the funnel plots and regression tests. The summary estimates were presented with forest plots and tables. RESULTS: = 92.1%, p < 0.001). The highest mortality was observed in the Central African region (41.00%, 95% CI: 27.62, 54.37), followed by Western (16.89%, 95% CI: 8.47, 25.32), Southern (14.57%, 95% CI: 10.86, 18.29), and Eastern Africa region 11.33% (95% CI:9.63, 13.04). Factors like being rural residents (Pooled Odds Ratio (POR) = 1.5, 95% CI: 1.12, 1.90), low hemoglobin (POR = 7.41, 95% CI: 2.20, 12.61), extrapulmonary tuberculosis (EPTB) (POR = 5.67, 95% CI:1.68, 9.66), severe immunosuppression (POR = 5.82, 95% CI: 1.55, 10.08), and poor antiretroviral therapy (ART) adherence (POR = 10.17, 95% CI: 3.52, 16.82) were found to increase the odds of mortality. Conversely, Cotrimoxazole Preventive Therapy (CPT) (POR = 0.38, 95% CI: 0.02, 0.73) was observed as a protective factor of mortality. CONCLUSION: This study demonstrates that HIV-TB co-infected children in Africa have a high burden of mortality, underscoring the implementation of dual infection testing and prompt treatment to achieve the 2030 Sustainable Development Goal (SDG) target of mortality reduction. To reduce mortality, strengthening care and treatment are needed with a special focus on rural residents and regular screening of hemoglobin status, CD4 counts, ART adherence, and EPTB infection. Besides, CPT provision should be enforced via integrated HIV-TB health services in the continent. REVIEW REGISTRATION: It was registered in the International Prospective Registry of Systematic Reviews (PROSPERO) with registration number CRD42024542095.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,016 | 0,037 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,021 | 0,040 |
| Bibliométrie | 0,012 | 0,011 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».