title: Impact of tuberculosis exposure at home on mortality in children under 5 years of age in Guinea-Bissau.
abstract: OBJECTIVE
  To assess mortality related to exposure to tuberculosis (TB) at home among children in urban areas of Guinea-Bissau.
  
  
  METHODS
  In four suburban areas included in the demographic surveillance system of the Bandim Health Project in Bissau, the mortality of children aged <5 years living with an adult with TB was compared with the mortality of children in the general population.
  
  
  RESULTS
  Children <5 years of age exposed to an adult with intrathoracic TB had 66% higher mortality than unexposed children (HR 1.66, 95% CI 1.2 to 2.3). The risk was higher for children living in the same family as a TB case (HR 2.15, 95% CI 1.3 to 3.7) than for children living in the same house but not belonging to the same family as the TB case (HR 1.51, 95% CI 1.0 to 2.2). For children whose mother had TB, mortality was increased eightfold (HR 7.82, 95% CI 2.1 to 30). The risk of death was particularly increased from 6 months following exposure (HR 2.16, 95% CI 1.5 to 3.2) and the highest rate of excess mortality was found in children aged 3–4 years. Excess mortality was highest among children with close contact with an adult with sputum-positive pulmonary TB (HR 1.90, 95% CI 1.1 to 3.2), but contact with a sputum-negative case was also associated with increased mortality (HR 1.55, 95% CI 1.0 to 2.3). Adjusting for potential confounding factors did not change these results. The mortality among children living in the same houses 3 years earlier was not increased (HR 0.90, 95% CI 0.6 to 1.3).
  
  
  CONCLUSIONS
  Intimate family contact with a TB case represents a significant risk factor for child mortality in a low-income country.
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau. victorfranciscogomes@yahoo.co.uk
authors.forename: Victor F
authors.initials: VF
authors.lastname: Gomes
authors.forename: Andreas
authors.initials: A
authors.lastname: Andersen
authors.forename: Christian
authors.initials: C
authors.lastname: Wejse
authors.forename: Ines
authors.initials: I
authors.lastname: Oliveira
authors.forename: Fina J
authors.initials: FJ
authors.lastname: Vieira
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Joaquim
authors.forename: Cesaltina S
authors.initials: CS
authors.lastname: Vieira
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.forename: Per
authors.initials: P
authors.lastname: Gustafson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005192:Family Health; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008297:Male; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000401:mortality / Q000635:transmission*; D014504:Urban Health / Q000706:statistics & numerical data