Knowledge, attitudes, and practices on paediatric tuberculosis in rural Tanzania: insights for enhanced detection and...

Paediatric tuberculosis (TB) remains underdiagnosed worldwide, with nearly 50% of cases missed. This issue is especially prominent in high-burden settings, where data on healthcare capacity for paediatric TB detection are limited. We assessed the knowledge, attitudes, and practices (KAP) regarding paediatric TB among healthcare workers (HCWs), community health workers (CHWs), and families in rural Tanzania.

We conducted a cross-sectional KAP survey in Kondoa District (Dodoma Region) from November 2023 to October 2024. We measured knowledge and attitudes using validated questionnaires and assessed practices through reported TB-related activities.

Our sample included 87 HCWs, 86 CHWs, and 78 caregivers. Median knowledge scores (maximum = 18) were 11.2 (interquartile range (IQR) = 9.2-12.9) for HCWs and 8.9 (IQR = 7.9-9.8) for CHWs. Clinicians outperformed paramedical staff (P < 0.01), with those who had <5 years' experience scoring better. Attitude scores were high at 3.25/4 for HCWs and 3.1/4 for CHWs, with a moderate knowledge-attitude correlation among HCWs (ρ = 0.344, P = 0.001). Practice gaps were substantial: 17.2% of HCWs never diagnosed paediatric TB, only 24% referred for advanced diagnostics, and 38% of CHWs reported no cases. Although 92% of caregivers were aware of TB, only 1.8% of children had documented diagnoses.

Despite adequate knowledge, implementation gaps persist, suggesting systemic barriers. Strengthening diagnostics, referrals, training and stronger integration of CHWs into paediatric TB care pathways is essential.