Insufficient Implementation of Tuberculosis Screening and Prophylaxis in Child Contacts: a Situational Analysis

Background: Contact investigations and chemoprophylaxis are proven cost-effective and safe means to reduce TB-related morbidity and mortality in children living with pulmonary tuberculosis (PTB) cases. Aim: To evaluate the implementation of tuberculosis (TB) screening and chemoprophylaxis in child contacts of smear-positive adult TB cases, and to identify practical barriers experienced by the staff of community health centers (CHCs) in a rural area in Central Java, Indonesia. Methods: Firstly, a short questionnaire was used to collect information on whether children in the household were screened and received chemoprophylaxis through home visits or at the CHC. Secondly, semi-structured interviews and an FGD were performed with the TB officer, a nurse responsible for the TB program activities, the assistant of the TB officer, a medical doctor from the out-patient clinic, and the head of the CHC. The data was then independently analyzed using the theoretical thematic analysis, then the findings were compared and integrated into one set of themes. Results: Out of 67 child contacts, determined through record reviews and visits of smear-positive TB patients, only 5(7.5%) were screened. None was started on chemoprophylaxis. In-depth interviews and a focus group discussion with CHCs' staff identified shortcomings in organization and management of care, lack of awareness and knowledge among staff, limited understanding of caregivers, and practical obstacles related to the rural setting. Conclusions: A comprehensive approach is needed that matches these site-specific practical barriers and might require a redistribution of organizational power from health authorities to the CHCs