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Adherence to Isoniazid Preventive Therapy among Under-Five Children in Contact with Adult Bacteriologically Confirmed
Getachew Seid1, Tsegaye Tsedalu2, Marta Ayele3
1Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Insights
Adherence to isoniazid preventive treatment (IPT) for children under five in Addis Ababa was suboptimal, with over 20% not completing the six-month course. Improving family understanding of IPT benefits is crucial for tuberculosis prevention in child contacts.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- Tuberculosis Control
Background:
- The World Health Organization (WHO) recommends isoniazid preventive treatment (IPT) for at least six months for children under five with household contact to infectious tuberculosis (TB) cases.
- This study addresses the critical need to assess IPT adherence in eligible children exposed to pulmonary TB in Addis Ababa.
Purpose of the Study:
- To determine the adherence rates of children under five to IPT after contact with pulmonary TB patients.
- To identify barriers to IPT completion among this vulnerable population.
Main Methods:
- A mixed-methods study combining quantitative (prospective assessment of adherence) and qualitative (exploring barriers with healthcare professionals and families) approaches.
- Data collection occurred from July to December 2019 in Addis Ababa, utilizing structured datasheets and statistical analysis (SPSS v20).
Main Results:
- Isoniazid preventive treatment (IPT) uptake was 75.2% among eligible children.
- A significant proportion, 21.3%, did not complete the full six-month IPT course.
- Lack of HIV testing was the only significant factor associated with defaulting from IPT (P < 0.001).
Conclusions:
- IPT enrollment and adherence rates in Addis Ababa fall short of WHO End TB strategy targets.
- Child default suggests a gap in family understanding regarding the benefits and safety of IPT for young children.
- Enhanced awareness campaigns by health extension workers are recommended to improve IPT outcomes and achieve strategic goals.
Background:
The World Health Organization recommends that all children below the age of five who have household contact with an infectious tuberculosis case should receive isoniazid preventive treatment for at least six months after the active tuberculosis disease has been ruled out. This research aims to determine the adherence of children, eligible for isoniazid preventive treatment, to the treatment who had contact with pulmonary tuberculosis patients.
Methods:
A mixed study design was used to prospectively assess the adherence to IPT among children under the age of 5 in contact with pulmonary TB patients through the quantitative study design and barriers of adherence in view of health care professionals and the family of children through a descriptive qualitative study. The study was conducted from July 2019 to December 2019 in Addis Ababa. Data were collected by a structured datasheet from the selected health center registration book. Data were entered into Epi Data software and analyzed by using SPSS version 20. Descriptive statistical methods were used to summarize the sociodemographic characteristics of the study participants.
Result:
The ratio of the total number of pulmonary tuberculosis index cases recruited into the study to the number of child contacts aged less than 5 years was 1 : 1.32. The total isoniazid preventive treatment uptake in this study was 75.2%; one-fifth (21.3%) of the children who started IPT did not complete the full course of six-month isoniazid preventive treatment. Except for HIV not to be tested (P < 0.001), there was no significant association of the listed risk factors in default to complete the full six months of preventive treatment.
Conclusion:
Enrolment of eligible children for isoniazid preventive treatment in the urban city Addis Ababa was still below the target of the World Health Organization End tuberculosis strategy by 2030. The treatment adherence rate also needs a great deal of effort to achieve the strategy. Child default after the first visit indicates a lack of understanding about the benefit and safety of preventive therapy in young children among families of TB patients, and awareness-creating efforts by health extension workers will help to improve the outcomes.
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