New research shows children ‘falling through cracks’ in TB care process

• A study by a Stellenbosch University-based researcher has found a number of children diagnosed with TB are not reported to their local childcare facilities.
• The research investigated the TB care cascade and suggested a hospital-based intervention that would see 98% of children successfully referred.
• The intervention also reduced the hospital-reporting gap from 38 to 16%.

A new study has found that nearly 10 000 children did not complete the TB treatment process at local healthcare facilities in one year.

The research, carried out by Dr Karen du Preez from the Desmond Tutu TB Centre at Stellenbosch University's Faculty of Medicine and Health Sciences, found many children were diagnosed at hospitals but not referred for treatment at their local healthcare facilities.

"In South Africa, thousands of children with TB fall through the cracks because they are either undiagnosed or diagnosed but unreported. To ensure proper diagnosis and reporting, TB programmes need good monitoring and evaluation tools as well as reliable and complete TB surveillance data for children," said Du Preez. She found nearly 10 000 children were lost in the reporting process of TB cases in 2018.

The researcher proposed a "relatively simple, hospital-based intervention" could close the gap in reporting children diagnosed at hospitals and ensure a continuation of TB care once they were discharged back to their local primary healthcare facility.

Du Preez investigated the role of diagnostic and treatment surveillance strategies to inform a paediatric TB "care cascade" that can be used in South Africa. A care cascade for TB depicts all the sequential steps that are needed to ensure treatment is successful. 

"Our intervention to support community referrals resulted in 98% of children being successfully referred and reduced the hospital-reporting gap at a large, referral hospital in Cape Town from 38 to 16%.

"This is quite significant if one considers that in 2018 only 65% of the estimated 27 000 children with TB in South Africa were reported to the TB programme."

The research had highlighted the value of patient-centred care and good communication to support children with TB (and their families) when moving between different levels of the healthcare system, said Du Preez.

"Ideally, we would want all children with TB to have access to health services, receive a diagnosis, to start and successfully complete TB treatment and to survive without any remaining illness.

"We know, however, that at each step in the cascade, some patients are lost. Quantifying the losses along the care cascade can help us to better respond to the TB epidemic in children and adolescents."