Quality of care in childhood tuberculosis diagnosis at primary care clinics in Kampala, Uganda

Abstract

SUMMARY OBJECTIVE: To assess the quality of routine childhood tuberculosis (TB) evaluation in Kampala, Uganda. SETTING AND DESIGN: This was a cross-sectional study of children aged <15 years attending six government-run clinics from November 2015 to December 2016. Clinicians completed a standardized patient record form for all child visits. We assessed the following performance indicators of TB evaluation developed based on the Desk Guide of the International Union Against Tuberculosis and Lung Disease, an evidence-based decision aid on childhood TB diagnosis and management for clinicians: proportion screened for TB symptoms or contact history, proportion referred for laboratory evaluation if screen-positive, and proportion treated for TB if test-positive or meeting clinical criteria. RESULTS: Of 24566 consecutive children enrolled, 11614 (47%) were fully screened for TB symptoms. Of 1747 (15%) children who screened positive, 360 (21%) had sputum examined, including 159 (44%) using smear microscopy, 244 (67%) using Xpert® MTB/RIF, and 52 (14%) using both techniques. Treatment was initiated in 18/20 (80%) children who tested positive. An additional 65 screen-positive children met the clinical criteria for TB; none were initiated on treatment. CONCLUSIONS: Large gaps exist along the pathway to diagnosis and treatment of childhood TB. There is an urgent need for enhanced implementation of evidence-based approaches to TB diagnosis to improve outcomes in childhood TB.

Evaluating the integration of tuberculosis screening and contact investigation in tuberculosis clinics in Ethiopia: A mixed method study

“…At the end of the study period, TB screening was conducted for over 98% of all children that attended the IMNCI clinics. This is much higher than findings from Uganda, where 47.0% of those <15 years were screened for TB symptoms [25]. In the same Ugandan study, however, 15.0% of the screened children were identified as presumptive TB, which is much higher than the 0.6% in our study.…”

Outcomes of empiric treatment for pediatric tuberculosis, Kampala, Uganda, 2010–2015

“…This contributes to 55% of child TB cases not being reported to national programs [2] from high TB burden settings have consistently documented that health care workers feel uncomfortable about making a TB diagnosis in a child and that there are often delays in care [7–9]. For example, a cross-sectional study of six primary clinics in Kampala found that no children who met clinical criteria for TB had been started on anti-TB treatment [10]. While algorithms exist to identify children with TB based on clinical factors [11–13], a concern is that without microbiologic confirmation, misdiagnosis could result in poor outcomes or adverse events from anti-TB treatment.…”

Provision of Decentralized TB Care Services: A Detect–Treat–Prevent Strategy for Children and Adolescents Affected by TB

“…However, TB is not systematically included in key policy frameworks, strategies, and operational tools to reduce child mortality, such as Integrated Management of Neonatal and Childhood Illnesses (IMNCI), or the management of acute malnutrition [44,45]. Providers of child and adolescent health services are not necessarily trained in basic TB prevention, diagnosis, and care; TB services are often managed and delivered separately by different providers [46]. Considerations around successful integration include: the selection of high yield service delivery points; human resource requirements (training as well as ongoing mentoring and supervision); referral pathways; and monitoring.…”