Abstract:

Introduction: Zimbabwe has consistently failed to meet the World Health Organization’s target of 10 to 15% of Tuberculosis (TB) notifications being children below 15 years, with the country experiencing a proportionate decline in childhood TB contribution to national notifications from 9% in 2011 to 5% in 2017.

Methodology: We conducted a descriptive cross-sectional study in 20 public sector health facilities across 4 districts. We abstracted childhood TB screening, diagnosis and treatment data from facility registers for the year 2019. Study was approved by local ethics committee and a waiver of consent was obtained for accessing patient data.

Results: Data for 21,791 children who accessed health services were abstracted, and 1,116 had documented TB management data. Overall, 3.1% of children were screened for TB; 0.8% for children below 5 years, 5.2% for ages 5-9, and 7.3% for ages 10-14 years. TB screening was significantly higher in referral (6.9%) than primary level (1.7%) facilities (p<0.05). About 63.2% of presumptive TB children had TB diagnostic tests; 51.2% for children below 5 years, 55.8% for ages 5-9 and 71.4% for ages 10-14 years. A majority (71.9%) of tests were conducted on GeneXpert MTB Rif platform and 17.9% were by microscopy. About 9.3% of tested children were diagnosed with TB, and 93.5% of these were initiated on treatment. Treatment outcomes for 65% of eligible children were evaluated.

References:

[1]    Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.1.

[2]    L.J. Nelson, C.D. Wells. Global epidemiology of childhood tuberculosis, Int J Tuberc Lund Dis, 8 (2004), pp. 636-647.

[3]    T.H. Lu, R.M. Huang, T.D. Chang, S.M. Tsao, T.C. Wu. Tuberculosis mortality trends in Taiwan: a resurgence of non-respiratory tuberculosis. Int J Tuberc Lung Dis, 9 (2005), pp. 105.

[4]    Y.P Yeh, H.J. Chang, J. Yang, S.H. Chang, J. Suo, T.H. Chen. Incidence of tuberculosis in mountain areas and surrounding townships: dose-response relationship by geographic analysis. Ann Epidemiol, 15 (2005), pp. 526.

B.J. Marais. Childhood tuberculosis: epidemiology and natural history of disease. Indian J Pediatr, 78 (2011), pp. 321-327.

Best Practices on TB case finding and treatment, reflections and lessons from West and Central Africa and beyond, October 2018 Geneva, Switzerland: https://www.theglobalfund.org/media/8273/core_

Zimbabwe National Tuberculosis and Leprosy Control Program annual report, 2018 Zimbabwe Population based HIV Impact Assessment, 2015-2016.

[5]   B.J. Marais, R.P. Gie, A.C. Hesseling, H.S. Schaaf, C. Lombard, D.A. Enarson, et al. A refined symptom-based approach to diagnose pulmonary tuberculosis in children, Pediatrics, 118 (2006), pp. e1350.

[6]    Zimbabwe Ministry of Health and Child Care National Tuberculosis Guidelines, 2016-2020.

[7]    The End TB Strategy, Global strategy and targets for tuberculosis prevention, care and control after 2015, May 2014: https://www.who.int/tb/strategy/End_TB_Strategy.pdf?ua=1, accessed 20 March 2020.

[8]    Bjerrum S, Rose MV, Bygbjerg IC, Mfinanga SG, Tersboel BP, Ravn P. Primary health care staff's perceptions of childhood tuberculosis: a qualitative study from Tanzania. BMC Health Serv Res. 2012; 12:6. Published 2012 Jan 9. doi:10.1186/1472-6963-12-6.

[9]    H.J. Zah, D. Hanslo, P. Apolles, G. Swingler, G. Hessey. Induced sputum versus gastric lavage for microbial confirmation of pulmonary tuberculosis in infants and young children: a prospective study. Lancert, 365 (2005), pp. 130.

[10]       Borgdorff MW, Nagelkerke NJD, Dye C, Nunn P. Gender and tuberculosis: a comparison of prevalence surveys with notification data to explore sex differences in case detection. Int J Tuberc Lung Dis. 2000;4(2):123–32.

[11]       Mueller-Hermelink Maya, Kobbe Robin, Methling Benedikt, Rau Cornelius, Schulze-Sturm Ulf, Auer Isa, Ahrens Frank, Brinkmann Folke. Universal screening for latent and active tuberculosis (TB) in asylum seeking children, Bochum and Hamburg, Germany, September 2015 to November 2016. Euro Surveill. 2018;23(12): pii=17-00536. https://doi.org/10.2807/1560-7917.ES.2018.23.12.17-00536.

[12]       Desalegn Dabaro. Factors affecting tuberculosis case detection in Kersa District, South West Ethiopia. J Clin Tuberc Other Mycobact Dis 9 (2017)1–4. [Accessed 15 July 2019].

[13]       Gregory K. Amenuvegbe, Anto Francis and Binka Fred. Low tuberculosis case detection: a community and health facility-based study of contributory factors in the Nkwanta South district of Ghana. BMC Res Notes (2016) 9:330.

WHO operational handbook on tuberculosis. Module 1: prevention - tuberculosis preventive treatment. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.