Health System Factors Influencing Childhood Tuberculosis Case Detection in the Cape Coast Metropolis, Ghana

Abstract

Background: Tuberculosis in children has historically been neglected by clinicians, policy makers, academics, and advocates due to several factors though it is significant contributor to child morbidity and mortality. In Ghana, the proportion of notified childhood TB cases among all cases gradually declined from about 6% in 2010 to 5% in 2015 after a steadily rising trend from 2.4% in 2008 to 5.9% in 2010 in spite of various interventions rolled out, with the expected figure pegged at 10%. Objective: This study sought to assess health system factors influencing childhood TB case detection in the Cape Coast metropolis. Methods: A quantitative cross sectional study based on the World Health Organization’s Childhood TB training toolkit, the Standard Operating Procedures for TB Case Detection for Ghana, March 2010 and the Toolkit to Address Timely TB Case Detection and Treatment (CARE II was conducted). Self-administered questionnaires were used to extract data from healthcare workers in the Cape Coast Metropolis who attend to children in their line of duty. The results were analysed to assess the knowledge levels of the healthcare workers, to describe their attitudes and practices, and reported views of healthcare workers on selected health system factors that influence the performance of healthcare workers. Results: The mean knowledge score was 49.6% (95%CI: 45.4-53.1) with 34.6% (37/107) of participants having adequate knowledge about childhood tuberculosis. Participation in childhood TB workshops was not associated with adequate knowledge level. Only 2.8% (3/107) of respondents knew the child TB control strategies.. 4.7% of the participants indicated that children with TB were discriminated against in health facilities and 29.9% were uncomfortable attending to children with TB. Frequency of childhood TB contact tracing and parental education varied across the different health facilities. Children were also not routinely screened for TB, and the symptom-based screening form was not used among children. Supervision was generally poor and practices of healthcare workers mostly at variance with the standard operating procedures. The health facilities also did not have copies of TB guidelines. The only TB reference guide available in the facilities was the TB Training Manual specifically at the Teaching Hospital and Metropolitan health directorate. Conclusion: Knowledge level of healthcare workers about childhood TB was generally inadequate. Negative attitudes to children with TB exist in health facilities and present a challenge to TB control. Diagnostic aids in the form of manuals and the standard operating procedures for TB case detection were generally lacking in the health facilities.