Quality of care in childhood tuberculosis diagnosis at primary care clinics 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 24 566 consecutive children enrolled, 11 614 (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.
Document Type: Research Article
Affiliations: 1: School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda 2: Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, California 3: Pulmonary, Critical Care, & Sleep Medicine Section, School of Medicine and Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut 4: Division of Pulmonary and Critical Care Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, and Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
Publication date: October 1, 2018
The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.
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