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Quality of care in childhood tuberculosis diagnosis at primary care clinics in Kampala, Uganda

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OBJECTIVE: To assess the quality of routine childhood tuberculosis (TB) evaluation 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.

Keywords: low-income countries; pediatric tuberculosis; quality

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

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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