Provider attitudes about childhood tuberculosis prevention in Lesotho: A qualitative study

Abstract Background : One million children developed tuberculosis in 2016, and at least 250,000 children died from TB. Implementation of effective child contact management is an important strategy to prevent childhood tuberculosis, but these practices often are not prioritized or implemented, particularly in low and middle income countries. Objective : To explore attitudes of healthcare providers toward tuberculosis prevention and perceived facilitators and challenges to child contact management in Lesotho, a high TB burden country. Design : Qualitative data were collected via group and individual in-depth interviews with 12 healthcare providers at five health facilities in one district, and analyzed using a thematic framework. Findings : Providers identified facilitators and challenges to a successful childhood tuberculosis prevention program. Facilitators included: provider understanding of the importance of tuberculosis prevention, and enhanced provider training on child contact management. Challenges included: (1) access to care, (2) supply-chain issues, (3) identification and screening of child contacts, and (4) adherence to isoniazid preventive therapy. Conclusions : Given the significant burden of tuberculosis morbidity and mortality in young children, prioritization of child contact management is imperative and should include enhanced provider training and mentorship, and strategies to eliminate challenges, including improved access to services, more efficient community screening using standardized tools, and delivery of intensive community health education about the importance of tuberculosis prevention.