An evaluation of childhood tuberculosis program in Chegutu District, Zimbabwe, 2020: a descriptive cross-sectional study

Abstract

Background Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the annual national childhood 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. Methods We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes, and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7™ to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. Results The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair knowledge of childhood TB notification. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400 mg was out of stock and adult 800 mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. Conclusion The childhood TB program failed to meet its targets due to inadequate inputs, HW suboptimal knowledge and COVID-19 lockdown measures. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

Impact of COVID‐19 measures on the health and healthcare of children in East‐Africa: Scoping review

“…Table 2 and Table 3 present the characteristics of these 70 studies 6,10–78 . Scale level: national ( n = 49), regional ( n = 21).…”

“…The 70 studies mention 7 indirect effects of COVID‐19 containment measures on the health and healthcare of children in 12 East‐African countries: economic damage ( n = 26), limited access to education ( n = 21), food insecurity ( n = 22), child abuse ( n = 12), limited access to healthcare ( n = 39), disrupted health‐programs (28), mental health challenges ( n = 13) 6,10–78 …”

“…The impact of COVID‐19 containment measures on the access to healthcare for East‐African children has been addressed in 39 studies 6,10,11,13–15,17,18,21,23,25,31,33–35,38–40,43–48,50,53,54,59,64–74 . Scale level: national ( n = 26) regional ( n = 13).…”

“…Studies from Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia and Zimbabwe illustrate that East‐African health‐systems are insufficiently equipped against strict COVID‐19 measures 6,10,11,13–15,17,18,21,23,25,31,33–35,38–40,43–48,50,53,54,59,64–74 . Disruptions in maternal and child health services have occurred due to lockdowns and economic decline in both inpatient and outpatient care 64,65 .…”

“…The impact of COVID-19 containment measures on the access to healthcare for East-African children has been addressed in 39 studies. 6,10,11,[13][14][15]17,18,21,23,25,31,[33][34][35][38][39][40][43][44][45][46][47][48]50,53,54,59,[64][65][66][67][68][69][70][71][72][73][74] Scale level: national (n = 26) regional (n = 13). Type of studies: original research (n = 34), reviews (n = 5).…”