Factors Contributing to Low Tuberculosis Detection Rates among Children Accessing Health Services in Selected Public Sector Health Facilities in Zimbabwe

Abstract

Introduction: Zimbabwe is one of 8 African countries with high per capita incidence of TB, TB/HIV and multi-drug resistant TB. Zimbabwe experienced a proportionate decline in childhood TB contribution to all notifications from 9% in 2011 to 5% in 2017. Methodology: Analytical cross-sectional study was conducted in 20 public sector health facilities. Data were collected from healthcare workers (HCWs) using structured questionnaires, interview guide for health managers and data abstraction tool for childhood TB data in registers. Protocol received ethical approval and written informed consent was obtained from participants. Results: Eighty-one HCWs and 18 managers were interviewed; data for 21,791 children were abstracted. About 3.1% of children were screened for TB, and 63.2% of presumptive TB children had TB diagnostic tests. A majority (71.9%) of TB tests were conducted on the Gen Xpert MTB Rif platform. Thirty-one out of 335 children with TB tests were diagnosed with TB, and 93.5% were initiated on treatment. Seven facilities offered TB testing, 5 had TB guidelines and 5 had pediatric TB job aides. Five out of 7 microscopes and 4/7 GeneXpert machines were functional. About 64.1% of HCWs had childhood TB training, 51% had ever received mentorship on childhood TB management, 53.1% had ever collected childhood TB diagnosis specimen and 23.3% had ever initiated children on TB treatment. Discussion: Childhood TB screening and diagnosis was suboptimal, and this was a result of low healthcare worker capacity, shortage and breakdown of TB diagnostic machines and weak TB diagnostic sample transportation system.