Isoniazide Preventive Therapy Uptake amongst Child Contacts of Adults Diagnosed with Smear Positive Pulmonary Tuberculosis in Selected Health Facilities in Douala, Cameroon

Abstract

Background: Childhood tuberculosis (TB) remains a major public health problem worldwide, especially in developing countries. Despite clear evidence that isoniazid preventive therapy (IPT) can reduce the risk of progression from TB infection to disease in TB contacts, uptake of IPT in children is low and IPT delivery is a challenge in many resource-limited settings with high TB-burden. Furthermore, the IPT initiation rates amongst child TB program implementation settings in Cameroon has not been reported and may be sub-optimal. Therefore this study was carried out to determine the level of IPT uptake and its associated factors amongst child contacts of adults diagnosed with smear-positive pulmonary tuberculosis (SPPTB). Methods: This was a mixed-method study involving quantitative and qualitative components. The quantitative component was conducted among child contacts of adult patients diagnosed with SPPTB (index case). Background, clinical, health facility, community and IPT related data were collected from 9 selected health facilities using interviewer administered questionnaires. Descriptive statistics was used to generate frequency tables and figures. Logistic regression analysis was performed to determine factors independently associated with IPT uptake. This was followed by qualitative phase which employed in-depth interviews (IDIs) with healthcare workers. The IDI sessions was taped, transcribed verbatim and analysed using a thematic approach. Results: A total of 513 child contacts were included amongst which 118 (23.0%; 95% CI: 19.6-26.9) had received IPT. Index cases aged 21-30 years [OR=34.712; (95% CI: 4.801-250.998); p<0.001] and 31-40 years [OR=10.094; (95% CI: 1.472-69.200); p=0.019], being the parents of the child contact [OR=2.142 ; (95% CI: 1.070-4.286); p=0.031] and sharing the same room with child [OR=3.939; (95% CI: 1.399-11.092); p=0.009] were associated with IPT uptake. Furthermore, child contact tracing [OR=5.783; (95% CI: 1.458-22.938); p=0.013], child contact screening [OR=39.308; (95% CI: 9.395-135.973); p<0.001], being educated on the benefits of ITP during anti-TB treatment [OR=3.865; (95% CI: 1.172-12.746); p=0.026], experiencing TB related stigma [OR=10.624; (95% CI: 3.188-35.410); p<0.001] and attending an accessible health facility [OR=4.021; (95% CI: 1.297-12.467); p=0.016] were also associated with IPT uptake. The level of knowledge on the benefits of IPT, continuous emphasis, education and sensitization on the need for IPT, good index case/health worker relationship, contact tracing and reduced cost of screening were seen to facilitate the uptake of IPT. Conclusion: This study showed that the implementation of IPT was 23%. Few child contacts of index cases are screened for active TB and even fewer are offered IPT. IPT uptake may be scaled up by simplifying screening procedures, providing free screening services, intensifying contact tracing, educating index cases at each hospital visit, maintaining good index case/health worker relationships, providing of health workers, improving logistics and enhancing supervision and monitoring.

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MPH.

Keywords

Tuberculosis, Cameroon, Smear Positive Pulmonary Tuberculosis

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