Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

Leonard Kibirige,Stephen Okoboi,Jonathan Izudi

doi:10.1186/s12879-021-06244-y

Abstract

IntroductionDiscontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives.MethodsWe conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes.ResultsOf 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38).ConclusionMany children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.

Highlights

Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death
Reasons for DTT in children Five sub-themes emerged as reasons for DTT from the qualitative study: 1) no privacy at the healthcare facility to people with TB and their treatment supporters; 2) the disappearance or symptom of TB reduction makes most people with TB discontinue treatment; 3) Poor implementation of community-based directly observed therapy short-course (DOTS) (CB-DOTS) hinders treatment continuation; 4) Insufficient funding prevents the follow-up of lost patients to continue TB treatment, and 5) Frequent stock out of TB drugs frustrates people with TB from continuing with treatment (Table 2)
In the adjusted analysis results (Table 3), DTT was more likely during the continuation phase of TB treatment compared to the intensive phase and when the treatment supporter was employed compared to when the treatment supporter was unemployed

Summary

Introduction

Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. Compared to adults with TB, in children, TB is associated with faster disease progression, severe and complicated forms of TB, and a higher risk of death [7]. Discontinuation of TB treatment (DTT) among children remains a global public health problem [8] and is worst in the subSaharan Africa region (1). DTT remains a major obstacle to efficient TB control in developing countries like Uganda and has the potential to worsen the emergence of multi-drug resistant TB and death [10, 11]

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Discussion

Conclusion