High levels of unfavourable treatment outcomes in children with drug-sensitive TB in Sierra Leone

SETTING: Ola During Children's Hospital, a tertiary-level paediatric facility affiliated with a university and located in Freetown, Sierra Leone. No published studies from Sierra Leone have evaluated treatment outcomes in children (<15 years) with drug-sensitive TB (DS-TB). OBJECTIVE: To assess compliance with national TB treatment guidelines and evaluate treatment outcomes among children with DS-TB. DESIGN: A non-concurrent cohort study, utilising routinely collected secondary patient data from TB treatment master cards. Poisson regression was done to calculate adjusted relative risks (aRR). RESULTS: Of 689 children, 95% received treatment regimens compliant with national guidelines. However, only 32% achieved favourable outcomes, while 68% had unfavourable outcomes (7% death, 30% loss to follow-up, 31% not evaluated). HIV co-infection (aRR = 1.2) and HIV-unknown status (aRR = 1.5), residence outside urban areas (aRR = 1.3), and extra-pulmonary TB (aRR = 1.2) were significantly associated with unfavourable outcomes. Children treated in 2023 (aRR = 0.7) and 2024 (aRR = 0.6) had better outcomes than those in 2022. CONCLUSION: Despite high compliance with treatment protocols, paediatric TB outcomes were alarmingly unfavourable. Strengthening follow-up systems and data recording, integrating TB-HIV services, and decentralising care are critical to improving outcomes in this vulnerable population.