Why do child contacts of multidrug-resistant tuberculosis not come to the assessment clinic?

Local policy advises that children exposed to multidrug-resistant tuberculosis (MDR-TB) should be assessed in a specialist clinic. Many children, however, are not brought for assessment.

Focus group discussion was used to design appropriate questionnaires. From 1 September 2011, the first 50 children referred to the specialist paediatric MDR-TB clinic, Cape Town, South Africa, and who attended their clinic appointment, were recruited. The first 50 children who were referred but who did not attend were concurrently identified, traced and recruited. Differences in group characteristics were compared.

The median age of the children was 35 months: 48 (48%) were boys, 4 (4%) were human immunodeficiency virus infected and 47 (47%) were of coloured ethnicity. Factors significantly associated with non-attendance at the MDR-TB clinic were: Coloured ethnicity (OR 2.82, 95%CI 1.21-6.59, P = 0.01), the mother being the source case (OR 3.78, 95%CI 1.29-11.1, P = 0.02), having a smoker resident in the house (OR 2.37, 95%CI 1.01-5.57, P = 0.04), the time (P = 0.002) and cost (P = 0.03) required to get to the specialist clinic, and fear of infection whilst waiting to be seen (OR 2.45, 95%CI 1.07-5.60, P = 0.03).

Reasons for non-attendance at paediatric MDR-TB clinic appointments are complex and are influenced by demographic, social, logistical and cultural factors.