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Kaumba PC, Siameka D, Kagujje M, Chungu C, Nyangu S, Sanjase N, Maimbolwa MM, Shuma B, Chilukutu L, Muyoyeta M. Knowledge, attitudes, and practices towards childhood tuberculosis among healthcare workers at two primary health facilities in Lusaka, Zambia. PLoS One 2024; 19:e0287876. [PMID: 38466675 PMCID: PMC10927107 DOI: 10.1371/journal.pone.0287876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Zambia is among the 30 high-burden countries for tuberculosis (TB), Human Immunodeficiency Virus (HIV)-associated TB, and multi-drug resistant/rifampicin resistant TB with over 5000 children developing TB every year. However, at least 32% of the estimated children remain undiagnosed. We assessed healthcare workers' (HCWs) knowledge, attitudes, and practices (KAP) towards childhood TB and the factors associated with good KAP towards childhood TB. METHODS Data was collected at two primary healthcare facilities in Lusaka, Zambia from July to August 2020. Structured questionnaires were administered to HCWs that were selected through stratified random sampling. Descriptive analysis was done to determine KAP. A maximum knowledge, attitude, and practice scores for a participant were 44, 10, and 8 points respectively. The categorization as either "poor" or "good" KAP was determined based on the mean/ median. Logistic regression analysis was performed to assess the associations between participant characteristics and KAP at statistically significant level of 0.05%. RESULTS Among the 237 respondents, majority were under 30 years old (63.7%) and were female (72.6%). Half of the participants (50.6%) were from the outpatient department (OPD) and antiretroviral therapy (ART) clinic, 109 (46.0) had been working at the facility for less than 1 year, 134 (56.5%) reported no previous training in TB. The median/mean KAP scores were 28 (IQR 24.0-31.0), 7 (IQR = 6.0-8.0) and 5 points (SD = 1.9) respectively. Of the participants, 43.5% (103/237) had good knowledge, 48.1% (114/237) had a good attitude, and 54.4% (129/237) had good practice scores on childhood TB. In the multivariate analysis, clinical officers and individuals with 1-5 years' work experience at the facility had higher odds, 2.61 (95% CI = 1.18-5.80, p = 0.018) and 3.09 (95% CI = 1.69-5.65, p = 0.001) of having good attitude respectively, and medical doctors had 0.17 lower odds (95% CI = 0.18-5.80, p = 0.018) of good childhood TB practice. Other participant characteristics didn't show a significant association with the scores. CONCLUSION The study found suboptimal levels of knowledge, attitude, and practices regarding childhood TB among HCWs. Targeted programmatic support needs to be provided to address the above gaps.
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Affiliation(s)
- Paul Chabala Kaumba
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | - Daniel Siameka
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | - Mary Kagujje
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | | | - Sarah Nyangu
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | - Nsala Sanjase
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | | | - Brian Shuma
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | - Lophina Chilukutu
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
| | - Monde Muyoyeta
- Centre of Infectious Disease Research in Zambia (CIDRZ), Mass Media, Lusaka, Zambia
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Kagujje M, Nyangu S, Maimbolwa MM, Shuma B, Mutti L, Somwe P, Sanjase N, Chungu C, Kerkhoff AD, Muyoyeta M. Strategies to increase childhood tuberculosis case detection at the primary health care level: Lessons from an active case finding study in Zambia. PLoS One 2023; 18:e0288643. [PMID: 37467209 PMCID: PMC10355435 DOI: 10.1371/journal.pone.0288643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/01/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION In high TB burden settings, it is estimated that 10-20% of total notifications should be children, however, currently only 6-8% of the total TB notifications in Zambia are children. We assessed whether the implementation of a multicomponent strategy, at primary healthcare facilities, that systematically targets barriers at each step of the childhood TB diagnostic cascade can increase childhood TB case detection. METHODS We conducted a controlled, interrupted time series analysis to compare childhood TB case notifications before (January 2018-December 2019), and during implementation (January 2020-September 2021) in two intervention and two control Level 1 hospitals in Lusaka, Zambia. At each of the intervention facilities, we implemented a multicomponent strategy constituting: (1) capacity development on childhood TB and interpretation of chest x-ray, (2) TB awareness-raising and demand creation activities, (3) setting up fast track TB services, (4) strengthening of household contact tracing, and (5) improving access to digital chest X-ray for TB screening and Xpert MTB/Rif Ultra for TB diagnosis, through strengthening sample collection in children. FINDINGS Among 5,150 children < 15 years screened at the two intervention facilities during the study period, 503 (9.8% yield) were diagnosed with TB. Of these, 433 (86.1%) were identified through facility-based activities (10.5% yield) and 70 (13.9%) were identified through household contact tracing (6.9% yield). Overall, 446 children (88.7%) children with TB were clinically diagnosed. Following implementation of the multicomponent strategy, the proportion children contributed to total TB notifications immediately changed by +1.5% (95%CI: -3.5, 6.6) and -4.4% (95%CI: -7.5, 1.4) at the intervention and control sites, respectively (difference 6.0% [95%CI: -0.7, 12.7]), p = 0.08); the proportion of childhood notifications increased 0.9% (95%CI: -0.7, 2.5%) each quarter at the intervention sites relative to pre-implementation trends, while declining 1.2% (-95%CI: -1.8, -0.6) at the control sites (difference 2.1% [95%CI: 0.1, 4.2] per quarter between, p = 0.046); this translated into 352 additional and 85 fewer childhood TB notifications at the intervention and control sites, respectively, compared to the pre-implementation period. CONCLUSION A standardized package of strategies to improve childhood TB detection at primary healthcare facilities was feasible to implement and was associated with a sustained improvement in childhood TB notifications.
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Affiliation(s)
- Mary Kagujje
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sarah Nyangu
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Minyoi M. Maimbolwa
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Brian Shuma
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Lilungwe Mutti
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Strategic Information Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Nsala Sanjase
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Andrew D. Kerkhoff
- Department of Medicine, University of San Francisco California, San Francisco, California, United States of America
| | - Monde Muyoyeta
- Tuberculosis Department, Centre of Infectious Disease Research in Zambia, Lusaka, Zambia
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Dongo JP, Graham SM, Nsonga J, Wabwire-Mangen F, Maleche-Obimbo E, Mupere E, Nyinoburyo R, Nakawesi J, Sentongo G, Amuge P, Detjen A, Mugabe F, Turyahabwe S, Sekadde MP, Zawedde-Muyanja S. Implementation of an Effective Decentralised Programme for Detection, Treatment and Prevention of Tuberculosis in Children. Trop Med Infect Dis 2021; 6:tropicalmed6030131. [PMID: 34287383 PMCID: PMC8293469 DOI: 10.3390/tropicalmed6030131] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is provided, along with findings from an external evaluation. The ongoing mentorship and practical support for health workers to deliver optimal services in this context were critical to complement the use of training and training tools. A summary of the project’s outcomes is provided along with the key challenges identified and the lessons learnt.
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Affiliation(s)
- John Paul Dongo
- International Union against Tuberculosis and Lung Disease, Kampala P.O. Box 16094, Uganda; (J.P.D.); (J.N.)
| | - Stephen M. Graham
- International Union against Tuberculosis and Lung Disease, Kampala P.O. Box 16094, Uganda; (J.P.D.); (J.N.)
- Centre for International Child Health, Department of Paediatrics and Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Melbourne 3052, Australia
- Correspondence: ; Tel.: +61-(0)405-782-505
| | - Joseph Nsonga
- International Union against Tuberculosis and Lung Disease, Kampala P.O. Box 16094, Uganda; (J.P.D.); (J.N.)
| | - Fred Wabwire-Mangen
- School of Public Health, Makerere University College of Health Sciences, Kampala P.O. Box 16094, Uganda;
| | - Elizabeth Maleche-Obimbo
- Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nirobi P.O. Box 30197-00100, Kenya;
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda;
| | | | - Jane Nakawesi
- Mildmay Uganda, Kampala P.O. Box 24985, Uganda; (R.N.); (J.N.)
| | - Gerald Sentongo
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala P.O. Box 72052, Uganda; (G.S.); (P.A.)
| | - Pauline Amuge
- Baylor College of Medicine Children’s Foundation-Uganda, Kampala P.O. Box 72052, Uganda; (G.S.); (P.A.)
| | | | - Frank Mugabe
- National Tuberculosis and Leprosy Program, Kampala P.O. Box 16069, Uganda; (F.M.); (S.T.); (M.P.S.)
| | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Program, Kampala P.O. Box 16069, Uganda; (F.M.); (S.T.); (M.P.S.)
| | - Moorine P. Sekadde
- National Tuberculosis and Leprosy Program, Kampala P.O. Box 16069, Uganda; (F.M.); (S.T.); (M.P.S.)
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda;
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Awaluddin SM, Ismail N, Yasin SM, Zakaria Y, Mohamed Zainudin N, Kusnin F, Mohd Yusoff MAS, Razali A. Parents' Experiences and Perspectives Toward Tuberculosis Treatment Success Among Children in Malaysia: A Qualitative Study. Front Public Health 2021; 8:577407. [PMID: 33384977 PMCID: PMC7770179 DOI: 10.3389/fpubh.2020.577407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: The trends of tuberculosis (TB) treatment success rate among children in Malaysia plateaued at 90% from 2014 to 2017. Malaysia sets a higher treatment success target of 95% to be achieved in line with an affordable, accessible, and holistic approach in managing TB among children. Objective: This study aims to explore the parents' experiences and perspectives toward achieving treatment success among children who were diagnosed with TB in two districts in Selangor state, Malaysia. Methods: The study was conducted using phenomenology study design via an in-depth interview of 15 mothers who were purposively sampled from the list of pediatric TB cases in the MyTB version 2.1 database in Klang and Petaling Districts of Selangor state. The R-based qualitative data analysis package of R version 0.2-8 was used to perform the thematic analysis. Results: Two main themes were identified from this study. The first theme was trust toward the healthcare services with the subthemes of acceptance, self-efficacy, holistic care, and perceived benefits. The second theme was the motivation to take or continue medication. The subthemes were support from family, healthcare workers' (HCWs') support, the convenience of healthcare services, community support, personal strength, and child's character. Conclusion: TB treatment success for children can be achieved when parents develop trust in healthcare services and have strong motivational factors to remain steadfast in achieving a successful treatment goal. Psychosocial support should be provided to the primary caregiver who faced any difficulty, while good relationships between parents and HCWs should be maintained. These results will inform the TB program managers to strengthen the holistic approach and identify the motivational factors among parents of children with TB disease.
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Affiliation(s)
- S Maria Awaluddin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Puncak Alam, Malaysia.,Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Nurhuda Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Siti Munira Yasin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Yuslina Zakaria
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | | | - Faridah Kusnin
- Klang District Health Office, Selangor Health State Department, Ministry of Health Malaysia, Putrajaya, Malaysia
| | | | - Asmah Razali
- Sector of TB/Leprosy, Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
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