Provider attitudes about childhood tuberculosis prevention in Lesotho: a qualitative study

Abstract

Background: The 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. Results: Healthcare 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. Conclusions: Given 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.

They do not have symptoms – Why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

“…This poor caregivers' knowledge of TPT was identi ed as a barrier to TPT initiation in India (8, 9), Ethiopia (27), Rwanda (28, 29), and South Africa (30). This limited knowledge could also lead to low community participation in screening children for latent TB infection and low TPT provision (19). In our context, due to a poor understanding of the importance of TPT to prevent active TB, acceptance of TPT for their eligible children was not prioritized for some caregivers.…”

“…In Kenya, non-adherence to Isoniazid preventive therapy was a factor demotivating providers from Isoniazid preventive therapy administration (5). Similarly, a study in Lesotho indicated that the fear of TPT's side effects was the main reason for poor TPT adherence (19). TPT side effects were also reported as a concern among caregivers and providers in India (9,20,21) and Indonesia (22).…”

Challenges Perceived by Health Care Providers for Implementation of Contact Screening and Isoniazid Chemoprophylaxis in Karnataka, India

“…The patients would have made an opinion before the health care workers reach out to them for child contact screening. A qualitative study carried out in Lesotho faced a similar challenge such as cost transportation due to the long distance to clinics from remote areas and stigma as the key challenge in pediatric contact investigation [ 9 ]. A study carried out by Belgaumber et al also suggested that stigma-related disclosure is one of the predominant barriers faced in pediatric contact screening [ 15 ].…”

“…A qualitative study conducted in Lesotho on facilitators and challenges in childhood TB prevention revealed that the key challenges were difficulties in access to care, supply-chain management issues, identification and screening of child contacts, and optimal adherence to isoniazid preventive therapy [ 9 ].…”

A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking

“…22 Drawing from literature excluded from our study, the prior review of contact case management in high-burden countries identified several barriers to completion of child contact management that overlap with our findings, including barriers posed by health systems, knowledge and attitudes, stigma, resource constraints, and treatment characteristics and adverse effects. 23 To highlight valuable explanatory research on TPT from LMIC included in that prior review and published subsequently, qualitative and mixed-methods studies have illustrated how (lack of) knowledge, [149][150][151][152] stigma, [152][153][154] patient/caregiver and health system resource constraints, 151 152 and combinations of these factors 155 conspire to impede TPT initiation and completion in LMIC.…”