Magnitude and effects of diabetes mellitus, malnutrition and HIV comorbidities on the management and outcomes of paediatric tuberculosis in Dar es Salaam and Pwani, Tanzania: a mixed-methods protocol
6 affiliations
- 1National Institute for Medical Reseach, Muhimbili, Dar es Salaam, Tanzania, United Republic of
- 2Kilimanjaro Christian Medical University College, Moshi, Tanzania, United Republic of
- 3Clinical Research, National Institute for Medical Research Muhimbili Research Centre, Dar es Salaam, Tanzania, United Republic of
- 4Kilimanjaro Clinical Research Institute, Kilimanjaro Clinical Research Institute, Moshi Urban, Kilimanjaro Region, Tanzania, United Republic of
- 5Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania, United Republic of
- 6Public Health, Kampala International University - Dar es Salaam College, Dar es Salaam, Tanzania, United Republic of
Abstract
Introduction: Tuberculosis (TB) remains among the leading causes of morbidity and mortality globally. Although children account for a substantial proportion of the TB burden, paediatric TB is frequently underdiagnosed because of limited bacteriological confirmation and non-specific clinical presentations. In many high-burden settings, including Tanzania, children with TB frequently present with comorbid conditions such as malnutrition, HIV infection and, increasingly, diabetes mellitus (DM). These comorbidities may influence susceptibility to infection, disease progression and treatment outcomes. Despite the increasing recognition of these interactions, limited research has investigated their combined magnitude and impact among children with TB in Tanzania. This study aims to determine the magnitude and effect of DM, malnutrition and HIV among children diagnosed with TB in the Dar es Salaam and Pwani regions.
Methods and analysis: This mixed-methods study will be conducted in 40 health facilities in Dar es Salaam and Pwani regions and is nested within the OPTIC-TB project. Quantitative components will include a cross-sectional analysis estimating the prevalence of DM, malnutrition and HIV among children with TB and a prospective cohort analysis evaluating treatment outcomes. Diagnostic delay and health-service utilisation will also be assessed. Data will be collected through structured caregiver questionnaires, anthropometric measurements, laboratory investigations and review of clinical records. Regression models will be used to assess associations between comorbidities and TB treatment outcomes while accounting for prespecified confounders and facility clustering. Qualitative interviews with caregivers and healthcare providers will explore barriers to and facilitators of paediatric TB diagnosis and management.
Ethics and dissemination: Ethical approval for the parent OPTIC-TB trial was granted by the National Health Research Ethics Committee of the National Institute for Medical Research (NIMR), Tanzania (Ref. NIMR/HQ/R.8a/Vol.IX/4754; extension Ref. NIMR/HQ/R.8c/Vol.I/3195, valid until 28 February 2027). This nested study was approved by the Kilimanjaro Christian Medical University College (KCMC) University Research Ethics Review Committee (Research Proposal No. 1617; Ethical Clearance Certificate No. 2807, valid until 5 March 2027). Written informed consent will be obtained from caregivers and assent from eligible children. Findings will be disseminated through peer-reviewed publications, scientific meetings and stakeholder engagement.
Registration number (Main OPTIC-TB trial): PACTR202501677523721.
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BibTeX
@article{mbuli2026magnitude,
title = {{Magnitude and effects of diabetes mellitus, malnutrition and HIV comorbidities on the management and outcomes of paediatric tuberculosis in Dar es Salaam and Pwani, Tanzania: a mixed-methods protocol}},
author = {Theresia William Mbuli and Blandina Mmbaga and Kaushik Ramaiya and Sayoki G Mfinanga},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-120133},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120133},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Magnitude and effects of diabetes mellitus, malnutrition and HIV comorbidities on the management and outcomes of paediatric tuberculosis in Dar es Salaam and Pwani, Tanzania: a mixed-methods protocol
AU - Theresia William Mbuli
AU - Blandina Mmbaga
AU - Kaushik Ramaiya
AU - Sayoki G Mfinanga
PY - 2026
DA - 2026/10/29
JO - BMJ Open
DO - 10.1136/bmjopen-2026-120133
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120133
AB - Introduction: Tuberculosis (TB) remains among the leading causes of morbidity and mortality globally. Although children account for a substantial proportion of the TB burden, paediatric TB is frequently underdiagnosed because of limited bacteriological confirmation and non-specific clinical presentations. In many high-burden settings, including Tanzania, children with TB frequently present with comorbid conditions such as malnutrition, HIV infection and, increasingly, diabetes mellitus (DM). These comorbidities may influence susceptibility to infection, disease progression and treatment outcomes. Despite the increasing recognition of these interactions, limited research has investigated their combined magnitude and impact among children with TB in Tanzania. This study aims to determine the magnitude and effect of DM, malnutrition and HIV among children diagnosed with TB in the Dar es Salaam and Pwani regions. Methods and analysis: This mixed-methods study will be conducted in 40 health facilities in Dar es Salaam and Pwani regions and is nested within the OPTIC-TB project. Quantitative components will include a cross-sectional analysis estimating the prevalence of DM, malnutrition and HIV among children with TB and a prospective cohort analysis evaluating treatment outcomes. Diagnostic delay and health-service utilisation will also be assessed. Data will be collected through structured caregiver questionnaires, anthropometric measurements, laboratory investigations and review of clinical records. Regression models will be used to assess associations between comorbidities and TB treatment outcomes while accounting for prespecified confounders and facility clustering. Qualitative interviews with caregivers and healthcare providers will explore barriers to and facilitators of paediatric TB diagnosis and management. Ethics and dissemination: Ethical approval for the parent OPTIC-TB trial was granted by the National Health Research Ethics Committee of the National Institute for Medical Research (NIMR), Tanzania (Ref. NIMR/HQ/R.8a/Vol.IX/4754; extension Ref. NIMR/HQ/R.8c/Vol.I/3195, valid until 28 February 2027). This nested study was approved by the Kilimanjaro Christian Medical University College (KCMC) University Research Ethics Review Committee (Research Proposal No. 1617; Ethical Clearance Certificate No. 2807, valid until 5 March 2027). Written informed consent will be obtained from caregivers and assent from eligible children. Findings will be disseminated through peer-reviewed publications, scientific meetings and stakeholder engagement. Registration number (Main OPTIC-TB trial): PACTR202501677523721.
SN - 2044-6055
SN - 2044-6055
ER -