Isoniazid preventive treatment among child contacts of adults with smear-positive tuberculosis in The Gambia

Egere, Uzochukwu; Sillah, Abdou K; Togun, Toyin; Kandeh, Sheriff; Cole, Fatoumatta; Jallow, Amadou T.; Able-Thomas, A.; Hoelscher, M; Heinrich, Norbert; Hill, Philip C.; Kampmann, Beate

doi:10.5588/pha.16.0073

Cited by 34 publications

(50 citation statements)

References 22 publications

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“…We found that 70% of <5 years old contacts started IPT, which is similar to reports from diverse settings for this age group: 64% in Ethiopia , 84% in South India and 79% in The Gambia . The pooled proportion of children of all ages starting TB preventive treatment in 8 studies was 69.1% in a systematic review .…”

Section: Discussionsupporting

confidence: 88%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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Objective Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. Methods We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. Results A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2–5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5–19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5–19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second‐degree relative to the index case (OR 6.6 95CI% 2.6–16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4–10.8), being contact of a smear‐negative index case (OR 5.5 95%CI 2.0–15.1) and attending a low‐caseload health facility (OR 2.8 95%CI 1.3–6.2). Factors associated to not starting IPT among 5–19 year‐olds were age (OR 13.7 95%CI 5.9–32.0 for 16‐19 vs. 5–7 years old), being a second‐degree relative (OR 3.0 95%CI 1.6–5.6), not having received a TST (OR 5.4, 95%CI 2.5–11.8), being contact of a male index case (OR 2.1 95CI% 1.2–3.5), with smear‐negative TB (OR 1.9 95%CI 1.0–3.6), and attending a high‐caseload health facility (OR 2.1 95%CI 1.2–3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5–7.9 for <5 year‐olds, and OR 4.3 95%CI 1.7–10.8 for those 5–19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6–33.8 for <5 year‐olds and OR 15.3 95%CI 1.9–125.8 for those 5–19 years old), and, only for those 5–19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4–7.7) and a health facility with low proportion of TB cases with treatment succ...

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Section: Discussionsupporting

confidence: 88%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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“…A final 255 of the 328 children (77.7%, 95% CI 73.2-82.2) completed the 6 months of IPT with good adherence. [23] Similar results were obtained in some other studies done in different parts of the world. [24,25] In a study done in South India, it was observed that none of the screened pediatric contacts were found to be TB diseased which was similar to our study and 97 (84%) contacts were initiated on IPT and 19 (16%) contacts were not initiated on IPT due to shortage of INH tablets in peripheral health centers.…”

Section: Discussionsupporting

confidence: 80%

A Study of the Status and Factors Affecting Isoniazide Chemoprophylaxis for Paediatric Contacts of the Smear Positive Tuberculosis Cases in East District of Sikkim in India

Zaman¹,

Mehta²,

Sharma³

2017

jemds

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BACKGROUNDThe state of Sikkim in India is overburdened with Tuberculosis (TB) in general and childhood TB in specific and is having the highest proportion of Multi Drug Resistant (MDR) TB cases in India. Isoniazide preventive therapy (IPT) has been found to be highly effective in preventing latent TB infection in children. MATERIALS AND METHODSIt was a prospective study with universal sampling method conducted amongst all the children under 6 years of age who were household contacts of sputum positive pulmonary TB cases being treated in East Sikkim district in the first two quarters of 2016. Home visits were done to find out the Isoniazid prophylactic therapy status along with factors for the compliance. Eligible children not on IPT were counselled to start Isoniazid (INH) and those who initiated were counselled to complete the entire course of IPT. Home visit were made again at the end of 6 months of initiation of treatment to note their IPT completion status. RESULTSOut of the total 30 pediatric household contact, 24 (80%) initiated IPT without any health education intervention. Among those who did not initiate IPT without any health education intervention, 4 out of 5 (80%) of them initiated IPT after the health education intervention showing a positive impact of the health education given to them. Lack of awareness about IPT amongst the parents was the most common reason cited by parents for those who did not initiate IPT. After 6 months of follow up, total 20 (71.4%) children were found to have completed the IPT. Among the children who did not initially initiate IPT and then started IPT after receiving health education, 75% of them (3 out of 4) were found to have completed IPT. CONCLUSIONHealth education intervention was found to be an effective tool for compliance of IPT. This study had a huge impact in terms of proving that the integration of preventive therapy for the contacts along with the treatment of the index case can be done with no extra burden and cost in the ongoing National Health Programme for TB. KEYWORDSIsoniazide Prophylaxis Therapy (IPT), Pediatric Contact, Smear Positive Tuberculosis. HOW TO CITE THIS ARTICLE:Zaman FA, Mehta VK, Sharma U. A study of the status and factors affecting isoniazide chemoprophylaxis for paediatric contacts of the smear positive tuberculosis cases in east district of Sikkim in India. J. Evolution Med. Dent. Sci. 2017;6(77):5486-5492, DOI: 10.14260/Jemds/2017/1191 BACKGROUND Tuberculosis (TB) in general & MDR-TB specifically affects the economically productive age group and has emerged as a significant socio-economic burden in India. Uncountable children in India have to leave school permanently and have to take up jobs in order to supplement the household income because of their parents' tuberculosis, and more women are rejected by their families because of having tuberculosis. [1,2] Nestled in the Himalayas, the small but beautiful north eastern state of Sikkim with a population of 6 lakh, encircled by Submission 14-08-2017, Peer Review 12-09-2017, Acc...

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“…A recurring theme throughout the different studies was the burden of travel for caregivers of children that had been advised to complete IPT. While financial cost was an issue for some, the duration of travel from people's homes to the nearest clinic appeared to be the principal issue for many . Seasonal farming demands and other family priorities, particularly for mothers, were often recognised as more important than taking children to the clinic .…”

Section: Discussionmentioning

confidence: 99%

“…The cost of treatment itself did not appear to present as significant an issue as travel overall; however, this was also mentioned as an obstacle in some areas . Many study participants and authors indicated that enhanced access to IPT through provision at peripheral health sites in rural areas could greatly contribute to improved uptake for children in these regions who may otherwise miss out on treatment . Strategies designed to minimise cost and maximise flexibility would give families the best chance of adhering to IPT.…”

Section: Discussionmentioning

confidence: 99%

Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

Grace

2019

J Paediatrics Child Health

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Isoniazid preventive therapy is one of the key interventions in reducing the risk of active disease among children exposed to tuberculosis. However, initiation and maintenance of this treatment is poor in many areas. This review summarises the existing literature on barriers to implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings. MEDLINE, EMBASE and CINAHL databases were used to search for primary research studies published between 1998 and 2018, specifically mentioning isoniazid preventive therapy, tuberculosis and children. Barriers identified in most study settings included absence of parental risk perception, health‐care worker knowledge gaps and treatment access. Focusing on patient‐centred care, enhancing community and health‐care worker education and securing stable medication supply to effectively deliver this therapy is crucial in order to reduce childhood morbidity and mortality from tuberculosis.

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Isoniazid preventive treatment among child contacts of adults with smear-positive tuberculosis in The Gambia

Cited by 34 publications

References 22 publications

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

A Study of the Status and Factors Affecting Isoniazide Chemoprophylaxis for Paediatric Contacts of the Smear Positive Tuberculosis Cases in East District of Sikkim in India

Barriers to the implementation of isoniazid preventive therapy for tuberculosis in children in endemic settings: A review

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