Evaluation of health-care providers’ knowledge of childhood tuberculosis in Lima, Peru

Abstract

Background:

As most national tuberculosis programmes (NTPs) focus on adult tuberculosis (TB), NTP providers may not appreciate differences in the pathophysiology and presentation of childhood TB.

Objectives:

This study aimed to identify strengths and weaknesses in knowledge of childhood TB among the 326 NTP providers in Lima Ciudad and Lima Este—two of the Peruvian capital’s four health districts.

Methods:

310 providers—103 physicians, 106 nurses, 101 nursing technicians—accepted personal invitations to complete self-administered surveys, which included 14 childhood TB questions grouped into five sections: transmission, symptoms, diagnosis, prevention and treatment. Physicians were asked ten additional questions targeting their NTP diagnostic and management responsibilities.

Results:

All three groups scored 97–99% on the transmission section and 83–85% on the treatment section; however, no group scored above 66% on any other section. Fewer than 50% of nurses and technicians recognised young children’s high risk of extrapulmonary TB, extrapulmonary TB symptoms or the causes of false negative tuberculin skin tests. Twenty-three per cent of physicians correctly identified gastric aspirate culture sensitivity, and 42% the radiographical findings of pulmonary TB. Less than two-thirds of providers recognised the definition of latent TB infection (LTBI), young children’s high risk of progression from LTBI to disease or indications for isoniazid preventive therapy.

Conclusions:

Providers at the frontline of Peru’s TB control efforts demonstrated weaknesses in the areas of extrapulmonary disease, diagnosis and prevention. These knowledge gaps are likely to have resulted in delayed or missed diagnoses and lost opportunities for prevention. Educational interventions targeting NTP personnel may improve childhood TB care and outcomes.

Keywords:

• Childhood TB
• Knowledge
• attitudes
• beliefs
• Isoniazid preventive therapy
• Extrapulmonary tuberculosis
• Diagnosis
• Lima
• Peru

Acknowledgments

We thank Jeffrey Starke and Liset Olarte for their comments on this manuscript, Judith Jiménez, Marco Monsalve, Eder Muñico, Silvia Soto and Karen Tintaya for piloting and distributing the surveys, and the NTP personnel who participated in the study.