Finding the missing children for TB care and prevention in Kenya

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Pediatric Health

Background:

• Tuberculosis (TB) remains a significant global health challenge, particularly affecting children.
• Improving access to TB preventive therapy (TPT) and enhancing diagnostic rates in pediatric populations are critical public health goals.
• Targeted interventions are needed in high TB burden settings to address pediatric TB effectively.

Purpose of the Study:

• To enhance the uptake of TB preventive therapy (TPT) among child contacts under five years old.
• To increase the diagnosis rate of TB in children under fifteen presenting for routine care.
• To evaluate the effectiveness of a combined health system strengthening approach in Kenya.

Main Methods:

• A clinic-based child contact management strategy was implemented, including cost reimbursements and healthcare worker education.
• Community health screeners were deployed in pediatric outpatient departments for verbal TB symptom screening.
• Data were collected over 15 months in 100 high TB burden facilities across nine Kenyan counties.

Main Results:

• Out of 2,022 identified child contacts, 91% were evaluated, and 8% were diagnosed with TB disease.
• Of those eligible, 95% initiated TPT, and 83% completed the therapy.
• Screening of 140,444 children in outpatient settings identified 39% with TB symptoms, leading to 4% diagnosed with TB disease.

Conclusions:

• Health system strengthening, particularly a clinic-based child contact management program, significantly increased TPT initiation among children.
• Systematic screening in outpatient clinics effectively increased TB case notifications in children.
• Further research is needed to optimize screening tools and diagnostic pathways for pediatric TB evaluation.