Shitol Sharmin Akter, Saha Avijit, Barua Mrittika, Towhid Kazi Md Saleheen, Islam Akramul, Sarker Malabika
James P. Grant School of Public Health, BRAC University, Medona Tower, 28 Mohakhali Commercial Area, Bir Uttom A K Khandakar Road, Dhaka-1213, Bangladesh.
National Tuberculosis Control Programme, Bangladesh.
Heliyon. 2023 Sep 30;9(10):e20569. doi: 10.1016/j.heliyon.2023.e20569. eCollection 2023 Oct.
As childhood tuberculosis is difficult to identify and diagnose, the experiences of the caregivers and healthcare providers of childhood tuberculosis patients remain a potential area of study. This study aims to illustrate the challenges caregivers and healthcare providers encounter in identifying and diagnosing childhood tuberculosis in two sub-districts of Bangladesh.
We conducted semi-structured in-depth interviews with eight caregivers of childhood tuberculosis patients and key informant interviews with 36 healthcare providers from September 2020 to December 2020 from different levels of the tuberculosis control program in Keraniganj (with high childhood tuberculosis cases notification), Faridpur Sadar (with low childhood tuberculosis cases notification), and Dhaka city.
There is a dearth of understanding among caregivers about childhood tuberculosis. Passive case finding process and focus on cough during community mobilisation contribute to the delay in childhood tuberculosis identification. The stigmatisation that caregivers anticipate and experience has an impact on their mental health and implies that there are misunderstandings about tuberculosis in the community. Furthermore, diagnostic dilemma among healthcare providers accounts for diagnosis delays. Some, but not all, institutions in different geographical locations provide free diagnostic tests and have GeneXpert devices.
Various factors, including caregivers' knowledge and experience, the process of case finding and community mobilization, healthcare providers' way of service provision and diagnosis, and the unavailability of required logistics at facilities challenge the identification and diagnosis of childhood tuberculosis that need to be minimized for childhood tuberculosis's early identification, diagnosis, treatment initiation, and successful completion of treatment. Awareness should also be raised in the community of childhood tuberculosis.
由于儿童结核病难以识别和诊断，儿童结核病患者的照料者和医疗服务提供者的经历仍是一个潜在的研究领域。本研究旨在阐明孟加拉国两个分区的照料者和医疗服务提供者在识别和诊断儿童结核病时所面临的挑战。
2020年9月至2020年12月，我们对8名儿童结核病患者的照料者进行了半结构化深入访谈，并对来自Keraniganj（儿童结核病病例通报率高）、Faridpur Sadar（儿童结核病病例通报率低）和达卡市不同层级结核病控制项目的36名医疗服务提供者进行了关键信息访谈。
照料者对儿童结核病缺乏了解。被动的病例发现过程以及社区动员期间对咳嗽的关注导致儿童结核病识别延迟。照料者预期并经历的污名化对其心理健康有影响，这意味着社区对结核病存在误解。此外，医疗服务提供者之间的诊断困境导致诊断延迟。不同地理位置的一些（但并非全部）机构提供免费诊断检测并拥有GeneXpert设备。
包括照料者的知识和经验、病例发现和社区动员过程、医疗服务提供者的服务提供和诊断方式以及设施中所需后勤物资的缺乏等各种因素，对儿童结核病的识别和诊断构成挑战，为实现儿童结核病的早期识别、诊断、开始治疗和成功完成治疗，需要将这些挑战降至最低。还应提高社区对儿童结核病的认识。
