Prevalence and factors associated with missed opportunities for tuberculosis diagnosis among children under 15 years attending Kitgum General Hospital Outpatient Department

Abstract

Background: Childhood TB remains a leading cause of death globally. In 2020, 1.1 million children fell ill with TB, but only 36.5% were reported to the WHO. An estimated 3 million TB cases are missed annually by healthcare systems, leading to delayed diagnosis, severe illness, and increased mortality. This study investigated the prevalence of missed opportunities for TB diagnosis and associated factors in children under 15 years at the KGH OPD. Methods: This was a cross-sectional mixed methods descriptive study conducted at the outpatient department of Kitgum General Hospital. Structured questionnaires were used to collect data from participants and TB tests were done for those found as missed opportunities for TB diagnosis. Key informant interviews were conducted for qualitative data. Quantitative data analysis was done using STATA version 15. Qualitative data was analyzed using content thematic approach. Patients found to have TB were started on TB treatment. Results: The prevalence for missed opportunities for TB diagnosis among children under 15 years attending KGH OPD was 7.2% (58/803) (95% CI: 5.43-9.01). Children whose parents had no formal education were 3 times more likely to miss opportunities for TB diagnosis compared to those whose parents had formal education (AOR, 3.4 95% CI (1.74-6.44), p = 0.001). Children aged between 11-14 years were 2 times more likely to miss opportunities for TB diagnosis (AOR = 2, 95% CI (1.11-4.67), p = 0.025) compared to those aged below 5 years. Children with fathers listed as their NOK were less likely to miss opportunities for TB diagnosis (AOR = 0.28, 95% CI (0.10-0.75), p = 0.012) compared to those who listed mother as NOK. Finally, children that resided in the rural areas were more likely to miss opportunities for TB diagnosis (AOR = 2.5, 95% CI (1.17- 5.50), p = 0.018) compared to those who resided in Urban areas. In qualitative analysis, inadequate human resources, insufficient training, lack of awareness on TB symptoms among the heath workers, logistical difficulties were the most reported healthcare provider factors associated with missed opportunities for TB diagnosis. The proportion of children who were diagnosed with TB disease among those who had missed opportunities for TB diagnosis was 23% (12/58). Conclusion: The study found a low prevalence of missed opportunities for TB diagnosis among children under 15 years attending KGH OPD. Strategies promoting family involvement, health literacy, comprehensive healthcare access and training of healthcare workers on TB diagnosis are therefore vital in reducing missed opportunities for TB diagnosis in children. Recommendations:We recommend the development and implementation of health literacy programmes to educate the caregivers on TB disease, there is also need to scale up mentorship trainings and refresher courses for the healthcare workers. We also recommend active involvement of men in healthcare programs, and active family engagement to be able to understand and address the health needs of children particularly the adolescents.