The authors declare that they have no competing interests.
SB designed the study, collected data, carried out the interviews and FGDs, analysed data and drafted paper. MVR designed and coordinated the study, contributed significantly to data collection, carrying out interviews and FGDs, data analysis and drafting of paper. SB and MVR reached consensus as regards coding. ICB contributed to designing the study, interpretation of data and provided critical feedback on preliminary analysis and draft of paper. SGM contributed to designing the study, interpretation of data and provided critical feedback on draft of paper. BPT contributed to designing the study, interpretation of data and provided critical feedback on draft of paper. PR participated in the conception, design and coordination of the study, contributed to interpretation of data and provided critical feedback on preliminary analysis and draft of paper. All authors read and approved the final manuscript
Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study explored primary health care staff's perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania.
We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis.
Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely differential diagnosis. Long duration and severe signs of disease together with known exposure to tuberculosis were decisive for the staff to suspect tuberculosis in children and refer them to hospital. None of the staff felt equipped to identify cases of childhood tuberculosis and they experienced lack of knowledge, applicable tools and guidelines as the main challenges. They expressed the need for more training, supervision and referral feedback to improving case identification.
Inadequate awareness of the burden of childhood tuberculosis, limited knowledge of the wide spectrum of clinical presentation and lack of clinical decision support strategies is detrimental to the health staff's central responsibility of suspecting and referring children with tuberculosis especially in the early disease stages. Activities to improve case identification should focus on skills required by primary health care staff to fulfil their responsibility and reflect primary health care level capacities and challenges.