ArticleBMJ public health2024
'We did not even know it was tuberculosis': a qualitative evaluation of integrating tuberculosis services into paediatric entry points in the CaP-TB programme in Cameroon and Kenya.
Article in BMJ public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03862261 (Integrating Pediatric TB Services Into Child Healthcare Services in Africa. A Cluster-randomized Stepped-wedge Trial), which is not on this map. Not yet cited in PubMed.
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Integrating Pediatric TB Services Into Child Healthcare Services in Africa. A Cluster-randomized Stepped-wedge Trial
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15 authors.
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Abstract
Introduction: Paediatric tuberculosis (TB) is often undiagnosed and under-reported. The Catalysing Paediatric TB (CaP-TB) programme provided integrated and decentralised TB screening and diagnosis services through multiple paediatric care entry points. This qualitative evaluation explores acceptability of the CaP-TB programme and existing knowledge and perceptions of paediatric TB. Methods: A descriptive qualitative study was conducted in four sites in Kenya and six sites in Cameron. 54 in-depth interviews were conducted with caregivers, community workers (CWs) and CaP-TB programme managers, and 7 focus group discussions with healthcare workers (HCWs) and CWs. Thematic analysis identified emerging recurrent themes across participants' responses. Data were coded by using MAXQDA V.12. Data were collected during March-September 2021. Results: Caregivers were often not aware that children were at risk for TB. HCWs reported limited knowledge about paediatric TB prior to CaP-TB. Sometimes caregivers refused to have their children tested for paediatric TB, and this was often related to a lack of awareness of paediatric TB and free services, concerns about the testing procedure and treatment and fear of stigma. TB was referred to as disease of 'shame,' associated with poverty and poor hygiene. The CaP-TB programme increased HCWs knowledge about symptoms of paediatric TB and motivation to investigate children with clinical presentations consistent with possible TB. Adding screening at all entry points was perceived to be beneficial to caregivers who would not have felt comfortable bringing their child to a TB unit. HCWs also discussed the increased workload with CaP-TB, challenges with medication stock-outs and a need for additional training. Conclusions: CaP-TB illustrated the positive impact of decentralised paediatric TB services, including addressing the awareness and knowledge gap among caregivers and HCWs. Multiple entry points increased opportunities for identification of paediatric TB and increased caregiver comfortability with their child being tested for TB. Trial registration number: NCT03862261.
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