Determinants and barriers of time to initiation of anti-tuberculosis treatment among children under 15 years at a Primary Health Care Center in Kampala, Uganda

Abstract

Background: Globally, it is estimated that 1,200,000 children under 15 years developed tuberculosis disease and this accounted for 12% of the global disease burden in 2019. The WHO reports that the diagnosis of TB in children under 15 years of age is a significant challenge in finding people with TB and therefore a barrier to ending TB as a global public health threat by 2030. Delay in initiation of anti-tuberculosis treatment beyond the recommended 30 days from onset of symptoms is associated with disease progression into significant morbidity and mortality. Study objective: To determine the median time to initiation of anti-tuberculosis medication and the associated determinants and barriers among children under 15 years at Kisenyi health centre IV. Methods: This was a convergent parallel mixed methods study. Quantitative data was collected through the review of 152 files of children under 15 years that were treated for TB at Kisenyi HC IV from 1st February 2021 to 28th February 2023. Kobo collect was used to data collection and analysis was done with STATA 17.Kaplan Meyer was used to estimate median time to initiation of TB medication from symptom onset. Cox proportional hazards regression was used to analyze variables that affect Median time to initiation of anti TB medication. Qualitative data was collected through key informant interviews among health care workers involved in the care of children with tuberculosis. Data was collected to the point of saturation. Thematic analysis will be used to describe the data. Results: A total of 152 children were recruited into the study. The median time to initiation of anti-TB medication was 39.5 days with IQR of 50.9 days. Pulmonary bacteriologically confirmed disease (HR; 0.54, 95%CI; 0.31-0.88, P value; 0.016) was found to be the only significant determinant of time to initiation of anti-TB medication. Barriers to promptly initiating anti-TB medication were high patient volumes, loss of community contacts, referral of children under 5 with suspected TB to Mulago, inadequate equipment and supplies and poor knowledge of childhood TB among caregivers. Recommendations: Research into more sensitive diagnostic tests to increase the proportion of children U15 with bacteriologically confirmed TB. Key words: Childhood TB, Paediatric tuberculosis, TB treatment delays, Barriers childhood TB, COM-B model.