Examining the quality of childhood TB diagnosis in Cambodia: a cross-sectional study
Abstract
Background
Cambodia is one of the 22
countries with the highest TB burden. While childhood TB is
estimated to make up 10–20% of total TB cases in
high-burden settings, this proportion ranges from 1.3 to 39.4%
throughout Cambodia’s provinces, suggesting potential
under- and over-diagnosis of childhood TB, subnationally. The
proportion of case notifications classified as extrapulmonary TB
out of total TB case notifications in children is 87%, greatly
exceeding the expected global range of 20–30%. There is a
gap in the literature on how childhood TB is diagnosed in
resource-poor settings, and the quality of diagnoses. The
study’s aim is to quantitatively assess the quality of
clinician performance and availability of diagnostic tools, for
diagnosing childhood TB in high-burden Operational Districts in
Cambodia.
Methods
Between August and September
of 2015, a cross-sectional study was conducted at referral
hospitals and villages in 24 high-burden Operational Districts.
40 clinicians, and 104 parents whose child was recently
diagnosed with TB were interviewed. Questionnaires assessed
availability of diagnostic tools, and clinician knowledge and
practice during a clinical examination. Descriptive statistics
were calculated to provide cross-sectional data.
Results
Availability of advanced
diagnostic tools was low. Only 27.5% of clinicians had Xpert
machines available at their facility, and 5% had equipment to
perform gastric aspiration. 77.5% of clinicians reported that
they had a chest X-ray at their facility, but only 34.6% of
parents reported that the clinician conducted a chest X-ray.
72.5% of clinicians could name 5 out of 7 main TB screening
criteria; however, parent data suggests that clinicians may not
be applying knowledge to practice. The mean number of
examinations/tests the clinician conducted during the clinical
assessment of the child was 1.64. Of the parents whose child had
an enlarged lymph node, 60.22% described lymph node
characteristics that were not suggestive of TB.
Conclusion
Limited availability of
diagnostic tools and suboptimal clinician performance highlight
where resources should be allocated to improve quality of
diagnoses. Further research needs to be done in low burden
Operational Districts to determine the capacity of clinicians
and health facilities for diagnosing childhood TB, where cases
are likely being missed.
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Source:
BMC Public Health
