The need to prioritise childhood tuberculosis case detection

Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources.Methods.Mache Chache(“Go and Seek”) was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance.Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities.Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment.

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Increased and Expedited Case Detection by Xpert MTB/RIF Assay in Childhood Tuberculosis: A Prospective Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/cis190 ◽

2012 ◽

Vol 54 (10) ◽

pp. 1388-1396 ◽

Cited By ~ 80

Author(s):

Andrea Rachow ◽

Petra Clowes ◽

Elmar Saathoff ◽

Bariki Mtafya ◽

Epiphania Michael ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Childhood Tuberculosis ◽

Case Detection

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An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

10.21203/rs.3.rs-1067049/v1 ◽

2021 ◽

Author(s):

Memory Chimsimbe ◽

Pride Mucheto ◽

Tsitsi Patience Juru ◽

Addmore Chadambuka ◽

Emmanuel Govha ◽

...

Keyword(s):

Detection Rate ◽

Cross Sectional Study ◽

Health Facilities ◽

Childhood Tuberculosis ◽

Health Concern ◽

Case Detection ◽

Sectional Study ◽

Cross Sectional ◽

Case Detection Rate ◽

Childhood Tb

Abstract Background Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the national 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. Methods We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7TM to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. Results The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair childhood TB notification knowledge. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400mg was out of stock and adult 800mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. Conclusion The childhood TB program failed to meet its targets due to inadequate inputs and suboptimal HW childhood TB knowledge. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

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