Gaps in the Child Tuberculosis Care Cascade in 32 Rural Communities in Uganda and Kenya

Florence Mwangwa, Gabriel Chamie, Dalsone Kwarisiima, James Ayieko, Asiphas Owaraganise, Theodore D Ruel, Albert Plenty, Khai Hoan Tram, Tamara D Clark, Craig R Cohen, Elizabeth A Bukusi, Maya Petersen, Moses R Kamya, Edwin D Charlebois, Diane V Havlir, Carina Marquez, Florence Mwangwa, Gabriel Chamie, Dalsone Kwarisiima, James Ayieko, Asiphas Owaraganise, Theodore D Ruel, Albert Plenty, Khai Hoan Tram, Tamara D Clark, Craig R Cohen, Elizabeth A Bukusi, Maya Petersen, Moses R Kamya, Edwin D Charlebois, Diane V Havlir, Carina Marquez

Abstract

Background: Reducing tuberculosis (TB) deaths among children requires a better understanding of the gaps in the care cascade from TB diagnosis to treatment completion. We sought to assess the child TB care cascade in 32 rural communities in Uganda and Kenya using programmatic data.

Methods: This is a retrospective cohort study of 160,851 children (ages <15 years) living in 12 rural communities in Kenya and 22 in Uganda. We reviewed national TB registries from health centers in and adjacent to the 32 communities, and we included all child TB cases recorded from January 1, 2013 to June 30, 2016. To calculate the first step of the child TB care cascade, the number of children with active TB, we divided the number of reported child TB diagnoses by the 2015 World Health Organization (WHO) child TB case detection ratio for Africa of 27%. The remaining components of the Child TB Care Cascade were ascertained directly from the TB registries and included: diagnosed with TB, started on TB treatment, and completed TB treatment.

Results: In two and a half years, a total of 42 TB cases were reported among children living in 32 rural communities in Uganda and Kenya. 40% of the children were co-infected with HIV. Using the WHO child TB case detection ratio, we calculated that 155 children in this cohort had TB during the study period. Of those 155 children, 42 were diagnosed and linked to TB care, 42 were started on treatment, and 31 completed treatment. Among the 42 children who started TB treatment, reasons for treatment non-completion were loss to follow up (7%), death (5%), and un-recorded reasons (5%). Overall, 20% (31/155) of children completed the child TB care cascade.

Conclusion: In 32 rural communities in Uganda and Kenya, we estimate that 80% of children with TB fell off the care cascade. Reducing morbidity and mortality from child TB requires strengthening of the child TB care cascade from diagnosis through treatment completion.

Keywords: Child Tuberculosis; HIV; HIV-exposed uninfected children; Tuberculosis Care Cascade.

Conflict of interest statement

CONFLICTS OF INTEREST: DVH has received non-financial support (donation of the drug Truvada [emtricitabine-tenofovir] for the SEARCH study from Gilead Sciences. The other authors do not have conflicts of interests to declare.

Figures

Fig. 1
Fig. 1
The Childhood TB Care Cascade for 32 rural communities in Kenya and Uganda. *The number of children with TB disease was calculated by dividing the number of recorded child TB cases (42) by the WHO case detection rate for Africa of 0.27 . The number of children diagnosed and linked to care, started on TB treatment, and completed TB treatment was extracted directly from the National TB Registries from the 32 communities in Kenya and Uganda.

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