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The MODS method for diagnosis of tuberculosis and multidrug resistant tuberculosis
Published on: August 11, 2008
Management of children exposed to Mycobacterium tuberculosis: a public health evaluation in West Java, Indonesia
Merrin E Rutherford1, Rovina Ruslami2, Melissa Anselmo1
1Centre for International Health, Faculty of Medicine, University of Otago, PO Box 913, Dunedin, New Zealand .
Insights
This study found significant performance gaps in Indonesia's child contact management for tuberculosis, highlighting issues with screening, therapy initiation, and adherence. Interventions are needed to improve child tuberculosis prevention and care.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Global Health
Background:
- Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries like Indonesia.
- Effective management of child contacts of adult TB patients is crucial for TB control and preventing childhood TB.
- Existing child contact management programs may have performance gaps that hinder their effectiveness.
Purpose of the Study:
- To qualitatively and quantitatively evaluate the performance of a child contact management program for adult TB patients in Indonesia.
- To identify specific gaps in screening, diagnosis, preventive therapy initiation, and adherence.
- To assess the knowledge, attitudes, and costs associated with child contact management from the perspectives of caregivers and clinic staff.
Main Methods:
- A public health evaluation framework was employed to assess performance indicators.
- Quantitative assessment of 755 child contacts across two cohorts, focusing on screening compliance, diagnostic accuracy, isoniazid preventive therapy (IPT) initiation and adherence.
- Qualitative data collection through interviews with 22 primary caregivers and 34 clinic staff, alongside cost recording.
Main Results:
- Significant performance gaps were observed: 82% for screening compliance, 50% for IPT initiation, and 54% for adherence.
- Diagnostic accuracy ranged from 64% to 100%, with 50% of costs being a barrier.
- Inadequate staff knowledge/attitude towards IPT and caregiver challenges with preventive therapy knowledge, travel, and costs were identified.
Conclusions:
- The Indonesian child contact management system exhibits widespread performance deficits amenable to targeted interventions.
- The public health evaluation framework is a valuable tool for assessing and improving child contact management programs in similar settings.
- Addressing knowledge gaps and logistical/financial barriers is essential for optimizing child TB contact management.
Objective:
To investigate qualitatively and quantitatively the performance of a programme for managing the child contacts of adult tuberculosis patients in Indonesia.
Methods:
A public health evaluation framework was used to assess gaps in a child contact management programme at a lung clinic. Targets for programme performance indicators were derived from established programme indicator targets, the scientific literature and expert opinion. Compliance with tuberculosis screening, the initiation of isoniazid preventive therapy in children younger than 5 years, the accuracy of tuberculosis diagnosis and adherence to preventive therapy were assessed in 755 child contacts in two cohorts. In addition, 22 primary caregivers and 34 clinic staff were interviewed to evaluate knowledge and acceptance of child contact management. The cost to caregivers was recorded. Gaps between observed and target indicator values were quantified.
Findings:
THE GAPS BETWEEN OBSERVED AND TARGET PERFORMANCE INDICATORS WERE: 82% for screening compliance; 64 to 100% for diagnostic accuracy, 50% for the initiation of preventive therapy, 54% for adherence to therapy and 50% for costs. Many staff did not have adequate knowledge of, or an appropriate attitude towards, child contact management, especially regarding isoniazid preventive therapy. Caregivers had good knowledge of screening but not of preventive therapy and had difficulty travelling to the clinic and paying costs.
Conclusion:
The study identified widespread gaps in the performance of a child contact management system in Indonesia, all of which appear amenable to intervention. The public health evaluation framework used could be applied in other settings where child contact management is failing.
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