Factors associated with unsuccessful tuberculosis treatment outcome in children in four provinces of Mozambique: a retrospective cohort study, 2018–2021

Tuberculosis (TB) remains a significant global public health challenge. Childhood TB treatment outcomes in Mozambique remain poorly understood. This retrospective cohort study aims to identify factors associated with unsuccessful outcomes in children. We analysed children (0–14 years) treated for TB between 2018 and 2021 in 16 selected health facilities. Logistic regression was undertaken to identify factors associated with unsuccessful outcomes reported as Odds ratios (ORs) with 95% confidence intervals. During the study period, a total of 1,421 children were included (211 in 2018, 380 in 2019, 600 in 2020 and 230 in 2021). Of these, 33.7% (479) were aged 0–4 years, 37.1% (527) 5–9 years, and 29.2% (415) 10–14 years. Females accounted for 50.3% (715), and 25.8% (367) were HIV positive. Pulmonary tuberculosis was the predominant form, representing 96.1% (1,366), while Extrapulmonary Tuberculosis (EPTB) comprised 3.9% (55). Unsuccessful outcome occurred in 5.6% (79) children. In multivariable regression model, several factors were independently associated with unsuccessful treatment outcome. Children aged 5–9 years had significantly lower odds of unsuccessful outcomes compared with those aged 0–4 years (model 1: aOR: 0.49 95% CI: 0.27–0.88; p = 0.017 and model 2: aOR: 0.44 95% CI: 0.24–0.80; p = 0.007). PTB was also associated with lower odds of unsuccessful outcome (model 1: aOR 0.33; 95% CI 0.14–0.78; p = 0.011 and model 2: aOR 0.39; 95% CI 0.16–0.96; p = 0.039). Compared to children treated in Maputo city, those in Maputo province (aOR 0.29; 95% CI 0.14–0.60; p = 0.01), Nampula (aOR 0.16; 95% CI 0.07–0.36; p < 0.01) and Zambézia (aOR 0.06; 95% CI 0.02–0.15; p < 0.01) had significantly lower odds of an unsuccessful outcome. Young children and those with EPTB were associated with unsuccessful treatment. Provincial disparities suggest inequities in pediatric TB care. Strengthening prevention, early diagnosis, management in young children, and service equity are needed to improve outcomes.