Uptake and Predictors of Isoniazid preventive therapy among child contacts of adults with Bacteriologically confirmed Tuberculosis in Moroto District

Abstract

Background: More than 10% of tuberculosis (TB) cases are pediatric and have a relatively higher risk of severe TB morbidity and mortality. TB infections in children can be prevented by Isoniazid Preventive Therapy (IPT) among child contacts of adults with bacteriologically confirmed TB however the uptake of the intervention is suboptimal. Objective: To determine the uptake and predictors of isoniazid preventive therapy among child contacts of adults with bacteriologically confirmed tuberculosis in Moroto district. Method: The study was a cross sectional study with a mixed methods of data collection. A total of 214 child contacts of adults with bacteriologically confirmed TB were consecutively sampled and engaged in structured interviews. Key informant interviews were conducted with healthcare service providers. Quantitative data was analyzed using SPSS 25 and qualitative data analyzed by thematic theme analysis. Association between variables was determined using prevalence ratios and a p value < 0.05 was considered significant. Results: About half 115(53.7%) of the child contacts of adults with bacteriologically confirmed TB had been initiated on isoniazid preventive therapy. Uptake of IPT was more likely among children aged less than 12 months (aPR = 1.986 [95% CI = 1.390 - 2.839]), children who were in contact with adult TB cases for less than a year (aPR = 1.670 [95% CI = 1.121 - 2.488]), and among those who had a tuberculin test (aPR = 2.121 [95% CI= 1.222 - 2.442], p = <0.001). IPT uptake was more likely among children whose parents or caretakers believed that every child who gets into contact with an adult with bacteriologically confirmed TB has to be initiated on IPT and a child infected with TB has a high risk of dying (aPR = 2.870 [95% CI = 1.451 - 5.679]), and (aPR = 3.088 [95% CI = 1.640 - 5.815]) respectively. Similarly, health education of parents or caretakers of children with TB by service providers about the need to have child contacts initiated on IPT (aPR = 2.208 [95% CI = 1.364 -3.576]), and the provision of adult cases with 1 -3-month long duration of TB treatment prescription (cPR = 2.322 [95% CI = 1.454 - 3.709], increased ITP uptake prevalence. IPT uptake was less likely among children who had been in contact with HIV positive adults (aPR = 0.503 [CI = 0.286 - 0.883]), in households where there were one to two children under five years (aPR = 0.102 [95% CI = 0.022 - 0.467]), and those whose adults got care from facilities with TB and HIV service integration (aPR = 0.301 [CI = 0.14 - 0.611], P = 0.046) Conclusion: For a district with a policy that involves identifying and tracking child contacts of adults with bacteriogically confirmed TB, Moroto has a sub optimal uptake of IPT among such children. Augmentation of IPT uptake will have to largely dwell on health education and behavior change communication interventions.