Assessment of factors that affect diagnosis and management of childhood tuberculosis among healthcare workers in Siaya county, Kenya

Abstract

Every day, up to 562 children die from Tuberculosis (TB). It is one of the top 10 causes of death and leading cause of death from single infectious agent. Diagnosis of childhood TB is key to its treatment by healthcare workers (HCWs) who often overlook it due to its difficulty to diagnose and treat. In 2019, 1.2 million children fell ill with TB, with 24 of the 30 TB HBCs accounting for 87% of new TB case are found in Africa. Kenya with a case notification rate (CNR) of 426/100,000, ranked 10th globally and 4th in Sub-Saharan Africa and notified 10,051 (10.4%), while Siaya County notified 98 (5.1%) cases (< 10-15% WHO’s recommendation) in 2018. Siaya county with 748/5344 deaths ranked 1st of 47 counties with >5% childhood TB in 2018. Estimating childhood TB’s global burden is challenging with up to 65% of children seeking services in health facilities (HFs) remain potentially missed or overlooked each year since HCWs using standard tests fail to detect TB up to 93% of the time. The study aimed to assess factors that affect diagnosis and management of childhood TB among HCWs in Siaya County. Specifically, it set out to determine influences of socio-demographic/socioeconomic factors, level of knowledge, HF based factors and constraints to childhood TB diagnosis and management in Siaya County. This cross-sectional study utilized a mixed method approach and enrolled 241 respondents obtained from 485 HCWs. Data was collected using questionnaires and KIIs. Chi square test of association was used to determine relationship between categorical variables while adjusted odds ratio with 95% confidence levels was used to quantify the strength of the relationship. Results revealed a significant association between socio-demographic characteristics; age (p=0.003), highest level of education (p=0.003) and current employer (p=0.047) being significantly associated with childhood TB diagnosis and management. Chi square test of association analysis linked attendance of seminar, training or workshop on childhood TB (p=0.012) and HF type (p=0.017) to childhood TB diagnosis and management. Further, stock-outs and correct dosing (p=0.012) emerged as constraints to childhood TB diagnosis and management. The results presented showed that; age of the HCW, their level of education, employer and frequent seminar, training or workshop on childhood TB, HF type and constraints were associated with correct childhood TB diagnosis and management in Siaya County. It recommended that decision makers at department level should prioritize employment of young (<30 years) HCWs with diploma, increasing frequency and intensity of attendance seminar, training or workshop on childhood TB, upgrade its HFs and streamline supply chain by addressing constraints which undermined diagnosis and management of childhood TB.