Administradora de Estancias Infantiles Salud Segura, Santo Domingo, Dominican Republic.
National Directorate of Epidemiology (DIGEPI), Ministry of Public Health, Santo Domingo, Dominican Republic.
BMC Infect Dis. 2022 Apr 11;22(1):359. doi: 10.1186/s12879-022-07333-2.
Throughout the world tuberculosis (TB) is the second leading cause of death due to an infectious agent. The World Health Organization promotes Isoniazid Preventive Therapy (IPT) in children under 5 years who are contacts of persons diagnosed with smear-positive pulmonary TB (SPPTB). In 2019, 33% of children identified as contacts received IPT globally, while in the Americas 11 countries reached coverages ≥ 75%, only 35% did so in the Dominican Republic (DR). The aim of this study was to identify barriers and facilitators for IPT administration in children under 5 in the Area IV Directorate of Health of the DR's National District.
Descriptive study, using mixed methods and sequential explanatory approach. We characterized children under 5 years who were contacts of a person with SPPTB. Later, semi-structured interviews and content analysis allowed identification of barriers and facilitators for IPT administration in children who were contacts of a person diagnosed with SPPTB, as perceived by relatives and health system personnel.
A total of 238 children were identified as contacts of 174 persons with SPPTB: 36% of these received IPT while no data on IPT administration was found for 11% of them. The proportion of children who had a tuberculin skin test (TST) done was < 20%. However, those who had the test done had a greater opportunity to receive IPT (OR: 8.12, CI 95%: 1.60-41.35). Barriers identified include socioeconomic conditions of children and families, stigma, lack of information in clinical and follow-up records, lack of coordination between public and private providers and lack of coherence within national regulations. Facilitators include home based care of persons with TB and their contacts, transfer of treatment to a health centre near household, isoniazid availability, provision of information by health-workers and economic support for food and transportation.
Incomplete data, lack of use of TST to rule out active TB, socioeconomic and cultural conditions, were barriers for IPT administration. Implementation of a person centred approach to care was found to be the main facilitator for IPT uptake. Administration of IPT depends predominantly on modifiable health system factors. This allows rapid identification of strategies to improve IPT administration.
在全球范围内，结核病（TB）是仅次于传染病的第二大死因。世界卫生组织（WHO）提倡对 5 岁以下与涂阳肺结核（PTB）患者有接触的儿童进行异烟肼预防治疗（IPT）。2019 年，全球有 33%的接触者被确定为儿童，而在美洲 11 个国家的覆盖率达到了≥75%，只有 35%的国家达到了这一水平，多米尼加共和国（DR）就是其中之一。本研究旨在确定 DR 国家区第四区卫生局的 5 岁以下儿童IPT 管理的障碍和促进因素。
采用混合方法和顺序解释方法进行描述性研究。我们对与涂阳肺结核患者有接触的 5 岁以下儿童进行了特征描述。随后，通过半结构访谈和内容分析，确定了被认为是与涂阳肺结核患者有接触的儿童的 IPT 管理障碍和促进因素，这些儿童是由亲属和卫生系统人员感知的。
共确定了 174 名涂阳肺结核患者的 238 名接触者：其中 36%的接触者接受了 IPT，而对于 11%的接触者，IPT 管理的数据尚未找到。进行结核菌素皮肤试验（TST）的儿童比例<20%。然而，那些接受了测试的儿童更有可能接受 IPT（OR：8.12，95%CI：1.60-41.35）。确定的障碍包括儿童和家庭的社会经济条件、耻辱感、临床和随访记录中缺乏信息、公私提供者之间缺乏协调以及国家法规内部缺乏一致性。促进因素包括对肺结核患者及其接触者的家庭护理、将治疗转移到家庭附近的卫生中心、异烟肼的供应、卫生工作者提供的信息以及对食品和交通的经济支持。
不完全的数据、缺乏使用 TST 来排除活动性结核病、社会经济和文化条件是 IPT 管理的障碍。实施以患者为中心的护理方法被认为是 IPT 使用率提高的主要促进因素。IPT 的管理主要取决于可改变的卫生系统因素。这使得快速确定改善 IPT 管理的策略成为可能。
