Finding the missing children for TB care and prevention in Kenya
OBJECTIVES: 1) To increase uptake of TB preventive therapy (TPT) among child contacts aged <5 years, and 2) to increase TB diagnosis in children aged <15 years presenting to health facilities for routine care.
DESIGN: For objective 1, a clinic-based child contact management strategy incorporating transport/healthcare cost reimbursement, monitoring and evaluation tools, and healthcare worker education was utilized. For objective 2, community health screeners were established in pediatric outpatient departments to perform verbal screening, flagging symptomatic children for further evaluation.
RESULTS: Over 15 months, identification of 8,060 individuals diagnosed with bacteriologically confirmed TB led to 2,022 child contacts. Of these, 1,848 (91%) were evaluated; 149 (8%) were diagnosed with TB disease, leaving 1,699 (92%) eligible for TPT; 1,613 (95%) initiated TPT and 1,335 (83%) completed TPT. In outpatient settings, 140,444 children were screened; 54,236 (39%) had at least two TB symptoms; 2,395 (4%) were diagnosed with TB disease
CONCLUSION: Health system strengthening supporting a clinic-based child contact management program increased the number of children initiating TPT. Systematic screening in outpatient clinics can lead to increased TB case notifications; however, optimal screening tools and clearer diagnostic pathways for the evaluation of these children are needed.
Keywords: Kenya; TPT; pediatric; prevention; tuberculosis
Document Type: Research Article
Affiliations: 1: Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA 2: Centre for Health Solutions-Kenya, Nairobi, Kenya 3: Centre for Health Solutions-Kenya, Nairobi, Kenya, Kenyatta National Hospital, Othaya, Kenya 4: Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA, Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA 5: Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program (DNTLDP), Nairobi, Kenya 6: The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, Stop TB Partnership, Geneva, Switzerland
Publication date: December 1, 2022
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