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PLoS One. 2014 Aug 29;9(8):e105935. doi: 10.1371/journal.pone.0105935. eCollection 2014.

Assessing the quality of tuberculosis evaluation for children with prolonged cough presenting to routine community health care settings in rural Uganda.

Author information

1
Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
2
Division of Pulmonary and Critical Care Medicine and Curry International Tuberculosis Center, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
3
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
4
MU-UCSF Research Collaboration, Kampala, Uganda.
5
Division of Infectious Diseases, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
6
Division of HIV/AIDS, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America; Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.

Abstract

BACKGROUND:

Improving childhood tuberculosis (TB) evaluation and care is a global priority, but data on performance at community health centers in TB endemic regions are sparse.

OBJECTIVE:

To describe the current practices and quality of TB evaluation for children with cough ≥2 weeks' duration presenting to community health centers in Uganda.

METHODS:

Cross-sectional analysis of children (<15 years) receiving care at five Level IV community health centers in rural Uganda for any reason between 2009-2012. Quality of TB care was assessed using indicators derived from the International Standards of Tuberculosis Care (ISTC).

RESULTS:

From 2009-2012, 1713 of 187,601 (0.9%, 95% CI: 0.4-1.4%) children presenting to community health centers had cough ≥ 2 weeks' duration. Of those children, only 299 (17.5%, 95% CI: 15.7-19.3%) were referred for sputum microscopy, but 251 (84%, 95% CI: 79.8-88.1%) completed sputum examination if referred. The yield of sputum microscopy was only 3.6% (95% CI: 1.3-5.9%), and only 55.6% (95% CI: 21.2-86.3%) of children with acid-fast bacilli positive sputum were started on treatment. Children under age 5 were less likely to be referred for sputum examination and to receive care in accordance with ISTC. The proportion of children evaluated in accordance with ISTC increased over time (4.6% in 2009 to 27.9% in 2012, p = 0.03), though this did not result in increased case-detection.

CONCLUSION:

The quality of TB evaluation was poor for children with cough ≥2 weeks' duration presenting for health care. Referrals for sputum smear microscopy and linkage to TB treatment were key gaps in the TB evaluation process, especially for children under the age of five.

PMID:
25170875
PMCID:
PMC4149493
DOI:
10.1371/journal.pone.0105935
[Indexed for MEDLINE]
Free PMC Article
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