Paediatric tuberculosis treatment outcomes: a retrospective study at the Komfo Anokye teaching hospital in Ghana, 2014–2025

INTRODUCTION: Tuberculosis (TB) remains a leading cause of morbidity and mortality among children, particularly those living with HIV in sub-Saharan Africa. Despite advances in integrating TB and HIV care in Ghana, long-term data on pediatric treatment outcomes across various age groups and nutritional statuses remain limited. This study aimed to determine TB treatment outcomes among children aged 0 to 14 years and assess the association of HIV co-infection and other factors on unsuccessful treatment outcomes. METHODS: A retrospective study was conducted using data from the Pediatric Tuberculosis Register at the Komfo Anokye Teaching Hospital between January 2014 and October 2025. All children included in this study were aged 0-14 years, confirmed with TB and on treatment were included. TB cases were clinically diagnosed, radiologically or bacteriologically confirmed. Treatment outcomes were classified according to the guidelines of the National TB Control Programme. Modified Poisson regression models with robust standard errors identified factors associated with unsuccessful outcomes, expressed as adjusted relative risk (ARR) with 95% confidence intervals (CI) using R statistical software version 4.4.1. RESULTS: Among 1,028 children analyzed, males were 56.8% [584/1028] and had a median age of 6.0 years (IQR 3-10). HIV prevalence stood at 53.2% [545/1,025]. Overall treatment success was 83.4% (857/1,028), with 16.6% [171/1,028] experiencing unsuccessful outcomes-comprising 8.9% [92/1,028] deaths and 7.7% [78/1,028] defaults. Treatment success rates ranged from 64.4% [56/87] in 2016 to 96.5% [110/114] in 2022. Multivariable analysis identified positive HIV status (ARR = 1.39, 95% CI 1.01-1.93, p = 0.044) and increasing age (ARR = 1.06 per year, 95% CI 1.02-1.10, p = 0.002) as significant predictors of unsuccessful treatment. Each additional year of age increased the risk of unsuccessful treatment by 8% (ARR = 1.08, 95% CI 1.04-1.12, p < 0.001). For underweight children with HIV, this interaction effect rose to 20% (ARR = 1.20, 95% CI 1.07-1.34, p = 0.002). CONCLUSIONS: The pediatric TB treatment success rate at KATH still falls short of the WHO target of 90%. Older age and HIV co-infection significantly increase the risk of unsuccessful treatment, with underweight children facing a greater risk. Strengthening integrated pediatric TB/HIV services through improved age-related enhanced adherence and nutritional support for adequate weight gain is crucial for improving outcomes and reducing default and mortality rates among children with TB in Ghana.