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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.037 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.040 |
| Bibliometrics | 0.012 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".