Epidemiology and Outcomes of Pediatric Multidrug-resistant Tuberculosis in Namibia: A Retrospective Review of National Registry Data From 2013 to 2023

BACKGROUND: Multidrug-resistant (MDR) and rifampin-resistant (RR) tuberculosis (TB) is challenging the national response to tuberculosis in Namibia. The recent introduction of Xpert MTB/RIF (Cepheid, Sunnyvale, CA) and the use of new and repurposed drugs have the potential to improve both management and outcomes. METHODS: Retrospective review of Namibian national registry data from 2013 to 2023 of children 0-14 years with MDR/RR-TB. National census data were used to estimate annual case notification rates (aCNRs). RESULTS: Totally 205 episodes were available for analysis. The median age was 4 years [interquartile range (IQR) 1-10]. Ninety (43.9%) were female and 20 (9.8%) were living with HIV. The aCNR increased by two-thirds from 1.2 in 2013 to 2.0 per 100,000 population in 2023. One region, Ojotzondjupa, notified 58 (28.3%) of all cases with a median aCNR of 7.1 per 100,000 population while the national median aCNR was 1.8 per 100,000 population. Ninety individuals (58.1%) received a treatment regimen containing injectables, whereas 65 (41.9.6%) received an all-oral treatment regimen containing two or more World Health Organization class A drugs and/or delamanid. Outcome was unfavorable in 46 (24.1%) individuals, and 18 (9.4%) died. No decrease in the proportion of children with unfavorable outcomes was observed over the study period. CONCLUSION: The epidemiology and outcome of children with MDR/RR-TB in Namibia are in keeping with the limited international data available; however, the geographical distribution of children with MDR/RR-TB poses a major challenge to the national TB response.