Barriers to childhood tuberculosis case detection and management in Cambodia: the perspectives of healthcare providers and caregivers

BMC Infectious Diseases

Research

Sivanna Tieng¹  Sok Heng Pheng¹  Chan Yuda Huot¹  Chhenglay Leng¹  Alvin Kuo Jing Teo²  Daisuke Nonaka³  Kim Eam Khun⁴  Siyan Yi⁵  Yom An⁶  Ngak Song⁷  Serongkea Deng⁸ 

[1] National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia;Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore;Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia;School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan;School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia;National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia;School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia;Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore;KHANA Center for Population Health Research, Phnom Penh, Cambodia;Center for Global Health Research, Touro University California, Vallejo, CA, USA;Sustaining Technical and Analytical Resources (STAR), The Public Health Institute (PHI), Phnom Penh, Cambodia;School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan;School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia;United States Agency for International Development, Phnom Penh, Cambodia;World Health Organization, Phnom Penh, Cambodia;

关键词: Tuberculosis;    Childhood tuberculosis;    Case detection;    Barriers to services;    Healthcare providers;    Caregivers;   

DOI  :  10.1186/s12879-023-08044-y

 received in 2022-08-08, accepted in 2023-01-30,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDiagnosis and treatment of tuberculosis (TB) in children remain challenging, particularly in resource-limited settings. Healthcare providers and caregivers are critical in improving childhood TB screening and treatment. This study aimed to determine the barriers to childhood TB detection and management from the perspectives of healthcare providers and caregivers in Cambodia.MethodWe conducted this qualitative study between November and December 2020. Data collection included in-depth interviews with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriologically confirmed pulmonary TB residing in the catchment areas of the selected health centers. Data were analyzed using thematic analyses.ResultsMean ages of healthcare providers and caregivers were 40.2 years (standard deviation [SD] 11.9) and 47.9 years (SD 14.6), respectively. Male was predominant among healthcare providers (93.8%). Three-fourths of caregivers were female, and 28.6% were grandparents. Inadequate TB staff, limited knowledge on childhood TB, poor collaboration among healthcare providers in different units on TB screening and management, limited quality of TB diagnostic tools, and interruption of supplies of childhood TB medicines due to maldistribution from higher levels to health facilities were the key barriers to childhood TB case detection and management. Caregivers reported transportation costs to and from health facilities, out-of-pocket expenditure, time-consuming, and no clear explanation from healthcare providers as barriers to childhood TB care-seeking. Aging caregivers with poor physical conditions, lack of collaboration from caregivers, ignorance of healthcare provider's advice, and parent movement were also identified as barriers to childhood TB case detection and management.ConclusionsThe national TB program should further invest in staff development for TB, scale-up appropriate TB diagnostic tools and ensure its functionalities, such as rapid molecular diagnostic systems and X-ray machines, and strengthen childhood TB drug management at all levels. These may include drug forecasting, precise drug distribution and monitoring mechanism, and increasing community awareness about TB to increase community engagement.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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