Prevalence of confirmed tuberculosis and factors influencing its management in children aged 12yrs and below presumed to have TB attending Bwizi Bwera health center iv, Mbarara district.

Abstract

In the year 2015, WHO estimated that there were one million incident cases and more than 240,000 deaths caused by TB; including children with HIV/TB co-infection. Children can get TB at any age, but usually, the infection and disease occur in children aged 1 to 4 years. Studies relating to childhood TB in Uganda, especially in the Western region have been sporadically conducted. More so, there is under-reporting and under-diagnosis of TB in children in Uganda which is likely to affect resource allocation and implementation of prevention and curative childhood TB programs. Objective The objective of this study is to determine the prevalence of Confirmed tuberculosis and factors influencing its management in children aged 12 years and below presumed to have TB attending Bwizi- Bwera Health center IV, Mbarara district. Methods This was a retrospective and prospective cross-sectional study design that employed both quantitative and qualitative data collection methods between January 2018 to December 2019 (two years’ period). Data abstraction tools were used to collect data from patients’ health/medical records and in-depth interviews (IDI) and key informant interviews (KI) were used to collect data from selected caretakers of pediatric TB cases and health care workers respectively. Analysis of quantitative data was done using Stata version 14 and the results have been presented using descriptive statistics, measures of association, graphs, and tables. Qualitative data analysis was done using Atlas Ti version 6 and results were presented under themes. Results The proportion of children below 12years who had TB was 32 (8.5%) out of 375 presumptive TB cases screened. 32 cases were diagnosed positive using the gene-expert machine. Qualitatively, the themes that arose were classified as social and cultural, individual, and health system factors. The social and cultural included issues relating to misconceptions, stigma, and discrimination, and social support. The individual factors that emerged included economic constraints, knowledge, attitude, and practices towards the management of childhood TB. Health system-related issues that emerged related generally to limitations in knowledge and number of human resources, services delivery, and information medicine management. Conclusion Children are a particularly vulnerable group and have increased health risks. The prevalence of childhood TB in Bwizi Bwera HC IV was relatively high. This study found out that the child’s age and HIV disease were associated with increasing TB among children. Distance to the facility, the size of the pill, understaffing, and insensitivity of the saliva that sometimes miss cases were factors affecting TB management among children. Results also showed that improved waiting time for patients and counseling improved the management of TB among the children. Interventions should be directed to improving the early detection of childhood TB by using the most sensitive method to screen the children and strengthening the health systems and quality improvement processes amidst the COVID-19 pandemic challenges to meet the international standard for TB control.