Cross Sectional Study Evaluating Routine Contact Investigation in Addis Ababa, Ethiopia: A Missed Opportunity to Prevent Tuberculosis in Children

In Ethiopia, the national TB and TB/HIV program guidelines recommend that all children who are close contacts of pulmonary TB patients should be screened for TB and managed accordingly. However, the implementation status of child contact screening and management in the health facilities of Addis Ababa, Ethiopia, is sub-optimal. A cross-sectional study was conducted in the primary health care setting of Addis Ababa to evaluate the implementation status of child contact screening and management. The study involved interviewing smear-positive PTB index patients and healthcare workers from September 16 to December 13, 2013, using structured questionnaires. A total of 688 smear-positive index tuberculosis patients were approached, of whom 203 (29.5%) reported having children five years and below in their household. The study found that 48 (23.6%) index cases had been requested by healthcare workers to bring their children for tuberculosis screening, and 45 (93.8%) had complied with this request. However, of the 230 children living with index smear-positive tuberculosis patients, 152 (66.1%) were not screened for tuberculosis, while 78 (33.9%) were screened, with 2 having tuberculosis and 76 screened negative. Only 3 (3.8%) of the children screened negative received preventive treatment. The study also found that none of the healthcare workers indicated routinely recording and reporting on child contact management. The implementation of household child contact screening and preventive intervention was sub-optimal in Addis Ababa, resulting in a missed opportunity to prevent tuberculosis in young children. Training of healthcare workers, availing simple symptom-based screening tools, and proper documentation could improve implementation. The national TB/HIV training manual for healthcare workers at all levels of care addresses basic childhood TB, including contact screening and management. However, the manual is not usually printed and made available for quick references at the health facility level. The national guideline recommends child contact screening and management, but there is no routine information available on this in the national TB program, making it difficult to know the status of implementation. The study highlights the need to investigate the status and barriers related to the implementation of child contact screening in Ethiopia and make practical recommendations to overcome observed challenges. The study's findings suggest that intensified prevention and control efforts are needed to address the burden of childhood TB in Ethiopia.