Abstract

BackgroundThe World Health Organization estimated that 1.12 million children developed tuberculosis (TB) in 2018, and at least 200,000 children died from TB. Implementation of effective child contact management is an important strategy to prevent childhood TB but these practices often are not prioritized or implemented, particularly in low- and middle-income countries. This study aimed to explore attitudes of healthcare providers toward TB prevention and perceived facilitators and challenges to child contact management in Lesotho, a high TB burden country. Qualitative data were collected via group and individual in-depth interviews with 12 healthcare providers at five health facilities in one district and analyzed using a thematic framework.ResultsHealthcare providers in our study were interested and committed to improve child TB contact management and identified facilitators and challenges to a successful childhood TB prevention program. Facilitators included: provider understanding of the importance of TB prevention and enhanced provider training on child TB contact management, with a particular focus on ruling out TB in children and addressing side effects. Challenges identified by providers were at multiple levels -- structural, clinic, and individual and included: [1] access to care, [2] supply-chain issues, [3] identification and screening of child contacts, and [4] adherence to isoniazid preventive therapy.ConclusionsGiven the significant burden of TB morbidity and mortality in young children and the recent requirement by the WHO to report IPT initiation in child contacts, prioritization of child TB contact management is imperative and should include enhanced provider training on childhood TB and mentorship as well as strategies to eliminate challenges. Strategies that enable more efficient child TB contact management delivery include creating standardized tools that facilitate the implementation, tracking, and monitoring of child TB contact management coupled with guidance and mentorship from the district health management team. To tackle access to care challenges, we propose delivering intensive community health education, conducting community screening more efficiently using standardized tools, and facilitating access to services in the community.

Highlights

  • The World Health Organization estimated that 1.12 million children developed tuberculosis (TB) in 2018, and at least 200,000 children died from TB

  • While many national TB programs have adopted the World Health Organization (WHO) guidelines, implementation of these guidelines in high TB burden countries remains limited with many countries experiencing operational challenges [11, 12], which result in poor Isoniazid preventive therapy (IPT) initiation and completion rates [13]

  • As healthcare providers are gatekeepers of contact management (CCM) implementation, we explored their attitudes toward TB prevention in children and perceived facilitators and challenges to CCM via qualitative interviews

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Summary

Introduction

The World Health Organization estimated that 1.12 million children developed tuberculosis (TB) in 2018, and at least 200,000 children died from TB. This study aimed to explore attitudes of healthcare providers toward TB prevention and perceived facilitators and challenges to child contact management in Lesotho, a high TB burden country. Given the significant burden of TB disease and mortality in young children, implementation of effective child TB contact management (CCM) is an important upstream strategy to prevent TB in children and provides an opportunity for early case detection and TB treatment initiation. While many national TB programs have adopted the WHO guidelines, implementation of these guidelines in high TB burden countries remains limited with many countries experiencing operational challenges [11, 12], which result in poor IPT initiation and completion rates [13]

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