Child contact management in high tuberculosis burden countries: A mixed-methods systematic review

Area of Science:

• Public Health
• Infectious Diseases
• Epidemiology

Background:

• Tuberculosis (TB) is a major global health concern, particularly for children.
• The World Health Organization recommends child contact management (CCM) to combat childhood TB.
• Effective implementation of CCM is essential to reduce TB-related morbidity and mortality in children.

Purpose of the Study:

• To systematically review the implementation, challenges, predictors, and recommendations for child contact management (CCM) in high TB-burden countries.
• To identify factors influencing CCM effectiveness and propose strategies for improvement.
• To provide evidence-based insights for optimizing CCM programs globally.

Main Methods:

• A mixed-methods systematic review was conducted, searching PubMed/MEDLINE, Scopus, and Web of Science for studies from 1996-2017.
• Studies focused on child contacts (<15 years) exposed to TB in high TB-burden countries, examining CCM strategies and outcomes.
• Included quantitative, qualitative, and mixed-methods studies, excluding randomized-controlled trials, editorials, and commentaries.

Main Results:

• Thirty-seven studies were reviewed, revealing significant variations in child contact losses during screening, preventive therapy initiation, and completion.
• Key challenges identified include infrastructure, knowledge gaps, stigma, access issues, and competing health priorities.
• Recommendations emphasize health system strengthening, health education, improved preventive therapy, and addressing barriers related to index cases, clinic characteristics, and treatment.

Conclusions:

• Child contact management (CCM) currently lacks standardization, leading to common challenges and losses throughout the care cascade.
• Prioritizing a CCM-friendly healthcare environment, enhancing CCM processes, and implementing active, evidence-based strategies can mitigate barriers.
• A focused approach across the entire CCM cascade is vital to reduce childhood TB and its associated burden.