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An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional
Memory Chimsimbe1, Pride Mucheto2, Tsitsi Patience Juru1
1Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe.
Insights
Childhood tuberculosis detection in Chegutu is low due to health worker confidence issues and resource shortages. Improving training and resources is key to boosting childhood TB case detection and notification rates.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Childhood tuberculosis (TB) presents a significant global health challenge, contributing to child morbidity and mortality.
- Chegutu District's childhood TB case detection rates (4% in 2018, 7% in 2019) fell below the national target of 12%.
Purpose of the Study:
- To evaluate the performance of the childhood TB program in Chegutu.
- To identify factors contributing to low childhood TB case detection rates.
Main Methods:
- A descriptive cross-sectional study involving 66 health workers (HW) using interviewer-administered questionnaires and checklists.
- Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was employed to assess program processes.
- Data analysis utilized Epi Info 7™ for frequencies, proportions, and means; a Likert scale assessed HW knowledge.
Main Results:
- Low case detection was linked to health worker confidence (83%) and attitudes (35%) regarding gastric aspirate collection.
- A significant knowledge gap in childhood TB notification was observed (37% had fair knowledge).
- Resource limitations included one functional X-ray machine for 34 facilities, inadequate functional motorcycles (6/18), and stockouts of essential TB drugs (Ethambutol).
- Programmatic failures included lack of desk guides, insufficient funding for vehicle maintenance, and inability to conduct planned reviews, contact tracing, and training due to funding and COVID-19 restrictions.
Conclusions:
- The childhood TB program underperformed due to insufficient resources, suboptimal health worker knowledge, and COVID-19 restrictions.
- Enhancing case detection and notification requires targeted interventions such as on-job training, mentorship, and improved supervision.
- Adequate resource allocation is critical for the effective implementation of childhood TB control programs.
Background:
Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu.
Methods:
We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge.
Results:
The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW's negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions.
Conclusion:
The childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.
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