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Glob Health Action. 2017;10(1):1290317. doi: 10.1080/16549716.2017.1290317.

Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth.

Author information

1
a School of Nursing , Duke University , Durham , NC , USA.
2
b Duke Global Health Institute.
3
c Department of Science and Society , Duke University , Durham , NC , USA.
4
d School of Medicine , Duke University , Durham , NC , USA.

Abstract

BACKGROUND:

Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood.

OBJECTIVE:

Timely initiation of tuberculosis (TB) treatment is critical to reducing disease transmission and improving patient outcomes. The aim of this paper is to describe patient- and system-level barriers to TB treatment initiation specifically for children and youth in sub-Saharan Africa through systematic review of the literature.

DESIGN:

This review was conducted in October 2015 in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six databases were searched to identify studies where primary or secondary objectives were related to barriers to TB treatment initiation and which included children or youth 0-24 years of age.

RESULTS:

A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children.

CONCLUSIONS:

Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes.

KEYWORDS:

Access; delay; global health; health systems; pediatrics

PMID:
28598771
PMCID:
PMC5496082
DOI:
10.1080/16549716.2017.1290317
[Indexed for MEDLINE]
Free PMC Article

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