Uptake of tuberculosis preventive therapy among eligible children under five years in Mombasa County, Kenya – Mixed methods observational study

Abstract

Background: In 2018, of the 1.5 million people dying of Tuberculosis (TB), 11% were children. Tuberculosis preventive therapy (TPT) reduces the risk of contracting active TB by 60%. TPT of children below five years with household contact of bacteriologically diagnosed TB cases in Kenya was at 34% in 2018. The aim of this study was to determine uptake of TPT among eligible children under five years and to assess the knowledge, attitude and practice of health care workers (HCWs) regarding TPT in Mombasa County that has a high TB burden.

Methods: A mixed methods cross-sectional study (October 2020-January 2021) was carried out at selected health facilities in Mombasa County, Kenya. Quantitative data was collected using structured questionnaires. Consecutive sampling of bacteriologically confirmed TB index cases was used to acquire the sample size of 150 eligible under five-year children per index case. Thematic coding of qualitative data from in-depth interviews (IDI) was conducted to evaluate barriers of TPT uptake from the perspective of; patients’, HCWs, and key informants in health facilities (n=20 for each).

Results: The uptake of TPT was 13.3%. The knowledge, attitude and practice among the health workers and index cases toward TPT was  60%, 80% and 68% respectively. The associated barriers to implementation of TPT included lack of  awareness on TPT, cumbersome  screening process, resistance by index cases,  poor socio-economic status, interrupted supply of TPT drugs and resistance of  caregivers/parents.

Conclusion. There is need to educate HCWs and the community on TPT importance and address the barriers.