Age-specific effectiveness of a tuberculosis screening intervention in children

Area of Science:

• Public Health
• Infectious Diseases
• Pediatrics

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries.
• Pediatric TB diagnosis and care present unique challenges, often leading to delayed or missed opportunities for effective management.
• A cascade-of-care framework provides a valuable tool for assessing patient flow and identifying bottlenecks in healthcare delivery.

Purpose of the Study:

• To evaluate the age-specific effectiveness of an intensified tuberculosis patient-finding intervention using a cascade-of-care approach.
• To identify age-related disparities in pediatric tuberculosis care pathways.

Main Methods:

• A prospective screening program was conducted at four hospitals in Pakistan from 2014-2016.
• A six-step care cascade was constructed: screened, positive screen, evaluated, diagnosed, started treatment, and successful outcome.
• Age-specific mean proportions and standard deviations were calculated for each step of the cascade in children aged 0-14 years.

Main Results:

• On average, 12.5% of children with a positive TB screen were not evaluated.
• The highest TB diagnosis rates were in younger children (0-4 years: 31.9%), with lower rates in older age groups (5-9 years: 22.4%; 10-14 years: 26.0%).
• Nearly all diagnosed children initiated treatment, achieving a successful outcome in 93.3% of cases across all ages.

Conclusions:

• The intensified intervention demonstrated high effectiveness across all pediatric age groups (0-14 years).
• Age-stratified cascade analysis is crucial for pinpointing specific gaps in pediatric TB care.
• This operational analysis can inform the development of targeted interventions to improve pediatric tuberculosis outcomes.