Factors hindering case tracing of pediatric tuberculosis in Dodoma municipality, Tanzania

Abstract

Background: Childhood Tuberculosis (TB) is among the top ten causes of childhood morbidity and mortality particularly in high-burden TB settings. According to 2012 Annual Report, the TB cases diagnosed and notified in Dodoma Municipal was 198/100,000; which is only 59% of what WHO recommends (333/100,000); the municipality diagnosed and notified only 39 TB cases of children aged 0-14 years. For children this figure is only 4.8% of the WHO recommendations. Aim of the study: The study aimed at finding out specific factors hindering case tracing of Tuberculosis in children in Dodoma Municipality. Methodology: A cross sectional descriptive study was done in April 2014 in Dodoma Municipality. It used purposive sampling technique to obtain 80 health care workers (HCWs) on convenience basis from all twelve TB diagnostic facilities and multistage cluster sampling technique to obtain 385 community members of Nzuguni ward. Self-administered questionnaire and interviewer guide were used for HCWs and community members respectively to collect demographic data, number of HCWs trained on TB related interventions, availability of TB tools/job aids, contact case tracing strategies and awareness of TB signs in children among community members. Data were sorted and processed using SPSS version 17. Descriptive statistics were generated and summarized for socio-demographic characteristics, TB trainings attended by HCWs, availability of job aids/tools and equipment, contact case tracing strategies. Community awareness of the signs and symptoms of TB in children were also analysed using descriptive statistics to find out those who had received any health education of Paediatric TB or had any information on TB sigs and symptoms in children. Results: Study population composed of 80 HCWs and 385 community members. Among the HCWs, 43(53.8%) were males and 37(46.2%) females. HCWs included 10(12.5%) Medical Officers, 20(25%) Assistant Medical Officers, 21(26%) were Clinical Officers and 2(2.5%) Clinical Assistants; Laboratory technicians were 13(16.2%), Laboratory Assistants 10(12.5%) the rest were put under others 4(5%). Among the community members, 167 (43.4%) were males and 218 (56.6%) females. The age of community members ranged from 18 to 81 years (mean =27.79 ± 10.80) and majority of them 304 (79%) were in the age group (18-34) years. Most of the study community members 192(49.9%) had secondary school education and only few 34 (8.8%) had no formal education. The most mentioned paediatric TB case detection challenges included; few staff trained on TB related trainings 53 (66.3%), about 17(31.5% and 15(57.7%) clinicians and laboratory staff had not attended any TB related training respectively; lack of awareness of parents about Paediatric TB 34 (62.9%), inadequate support for HCWs to visit homes of index patient 37 (68.5%) and difficult to read and interpret chest x-ray 33 (61.1%). None of HCWs reported to have Gene X-pert MTB/RIF at their facility. Conclusion: This field based study has established that; few HCWs are trained on TB related interventions, there is low awareness of the community of TB among children; difficult interpretation of chest x-ray results, unavailability of currently used equipment such as Gene X-pert MTB/RIF and inadequate TB contact case tracing strategies are factors influencing TB case tracing among children in Dodoma Municipality. Recommendations: The MOHSW/NTLP need to train more HCWs on Paediatric TB and other TB related trainings, in-service educational programs among HCWs will emphasize TB case detection, treatment as well as prevention of TB in children aged 0-14 years. The Provision of equipment (gene x-pert)/job aids to TB diagnostic health facilities in Dodoma Municipality is also very important ; more effort is needed to raise community awareness through health education towards TB in children and further studies are needed on why parents/caregivers provide wrong information/address when they have index TB patients (children & adults) .