Factors Influencing the Practices and Adherence of Isoniazid Prophylactic Therapy Among Under 5 Years Children in Tb Referral Units, Peshawar

Abstract

<i>Importance</i>: The under 5 years children of house hold contact with active tuberculosis cases is one of the main cause for the transmission of TB in pediatrics population, responsible for many complications and childhood mortality. <i>Objective</i>: To determine the factors influencing the practice and adherence of Isoniazid Prophylactic Therapy (IPT) among under 5 years children of house hold with cases of active pulmonary tuberculosis. <i>Design: </i>The study’s design was cross sectional. <i>Setting: </i>This study was conducted in TB referral units of the National Tuberculosis Control Program in Peshawar City. <i>Participants</i>: The study participants included patients with sputum-positive pulmonary TB having at least one under-5 years’ child in their household. Secondly, the doctors who were directly dealing with TB patients for diagnosis and treatments in referral units of the respective hospitals. <i>Results</i>: Most of the patients reported that doctors neither got some information about the under-5 years' children at their family nor to bring them for TB screening. Just 13.2% patients (36 out of 273) conceded that doctors mentioned them for prophylactic treatment with Isoniazid (INH) medication for their contact positive under-5years children. But only 4 of these 36 patients [(11.11%) 1.46%of the aggregate] completed the IPT course for their under-5 year children for 6 months duration. (Table 2) All the doctors claimed that they got information about the presence of under five years household contact in the family of TB patients. While the majority of the doctors/physicians (80%) had recognized that they neither requested the patients for screening from their family contact nor to give INH medication for their prophylaxis. This study showed that the practice of IPT was 13.2% and the adherence rate was just 11.11%, and the main factors for this poor result were poor healthcare system, lack of awareness, financial constraint and attitude of the patients. <i>Conclusion: </i>This study concludes that the extremely poor practice and adherence to isoniazid prophylactic therapy by doctors and patients in TB referral units in Peshawar city for under-5-year-old children of households with active tuberculosis patients was primarily caused by a lack of awareness, financial constraints, patient attitudes, and an inefficient healthcare system.