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

Abstract

Abstract Background: Childhood tuberculosis (TB) case detection remains low in many high-burden countries, including Cambodia. Healthcare providers and caregivers play a critical role 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. Method: We conducted this qualitative study between November and December 2020. In-depth interviews were done with 16 healthcare providers purposively selected from four operational districts and 28 caregivers of children with TB and children in close contact with bacteriological confirmed pulmonary TB residing under the coverage of the selected health centers. Data were analyzed using thematic analyses. Results: Mean ages of healthcare providers and caregivers were 40.19 years (standard deviation [SD] 11.89) and 47.93 years (SD 14.63), respectively. Male was predominant among healthcare providers (93.75%), whereas three-fourths of caregivers were female, and 28.57% of caregivers 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 of 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. Conclusions: The national TB program should further invest in staff development, such as developing a national strategy for human resources for TB and increasing staff motivation, including performance-linked incentives provision. Appropriate TB diagnostic tools (e.g., rapid molecular diagnostic systems and scale-up of functional X-ray machines) should also be rolled out. To avoid drug supply interruptions, childhood TB drug management at all levels should be strengthened, such as drug forecasting, a clear mechanism for drug distribution, and drug monitoring. Increasing community awareness about TB should also be prioritized to increase community participation.