Academic journal article Bulletin of the World Health Organization

Implementation of Tuberculosis Prevention for Exposed Children, Burkina Faso/Mise En Oeuvre D'actions De Prevention De la Tuberculose Pour Les Enfants Exposes Au Burkina Faso/Implementation De la Prevencion De la Tuberculosis Para Ninos Expuestos, Burkina Faso

Academic journal article Bulletin of the World Health Organization

Implementation of Tuberculosis Prevention for Exposed Children, Burkina Faso/Mise En Oeuvre D'actions De Prevention De la Tuberculose Pour Les Enfants Exposes Au Burkina Faso/Implementation De la Prevencion De la Tuberculosis Para Ninos Expuestos, Burkina Faso

Article excerpt

Introduction

The identification and treatment of individuals with latent Mycobacterium tuberculosis infection is an essential element of the World Health Organizations (WHO's) End TB Strategy. (1) Individuals with such infection, who are thought to make up between a third and a quarter of the world's population, act as reservoir hosts and may develop into active cases of tuberculosis when reactivation is triggered by any of several known risk factors. (2,3) Up to one third of the household contacts of humans with untreated tuberculosis of the respiratory tract become infected with M. tuberculosis and the risk of infection is relatively high if the active index case has severe disease, exposure to the case is prolonged and exposure to ultraviolet light and ventilation are poor. (3) Compared with older children, infants and very young children with latent infection are more likely to develop active tuberculosis, especially the severe and life-threatening forms of the disease. (3) Recommendations therefore suggest that all children younger than five years who are household contacts of cases of pulmonary tuberculosis should be screened for active tuberculosis and, if found free of the active disease and otherwise eligible, given preventive treatment. (4,5)

The percentage of eligible child contacts who begin preventive treatment (hereafter called treatment coverage) is considered to be among the top 10 priority indicators for measuring the progress of the End TB Strategy at global and national levels. (6) According to WHO, in 2016, an estimated 1.3 million children younger than five years were eligible for treatment for the prevention of tuberculosis. (7) Although treatment coverage appears to have almost doubled between 2015 and 2016, it was estimated to be just 13% in 2016. (7) Global figures on another indicator, the proportion of exposed children who are investigated to exclude active tuberculosis and, if eligible, start preventive therapy, are not yet available.

The screening and treatment of contacts younger than five years, as recommended by the WHO, probably occurs in most countries with a high burden of tuberculosis. (8) In 2016-2017, however, very few countries in WHO's Africa Region reported having any kind of scheme for the monitoring and evaluation of their interventions against latent tuberculosis infection. (9) In addition, very few such countries had any system for the routine reporting of four core indicators, i.e. the percentages of child contacts screened for active disease, eligibility for treatment for the prevention of tuberculosis, initiating such treatment and completing such treatment, that could give useful insights as to their interventions' efficiency. (9)

Burkina Faso is a resource-constrained country in West Africa that has a national tuberculosis programme and health-information system that appear similar to those of many other countries in sub-Saharan Africa. In 2015, Burkina Faso was one of the African countries that had no system for the monitoring and evaluation of latent tuberculosis infection and related interventions. (9) Although a national policy for the systematic screening and treatment of such infection among people living with human immunodeficiency virus (HIV) and children younger than five years was already in place, the country did not have an efficient relevant recording and reporting system and only noted the number of children who were started on treatment for the prevention of tuberculosis. (10) The programmatic management of latent tuberculosis infection in children younger than five years was implemented through a passive contact-tracing system that probably missed many children who were eligible for preventive treatment. (10)

In 2016, in response to the shortcomings in Burkina Faso's tuberculosis control initiatives, we modified two existing reporting forms and developed a monitoring and evaluation system for all of the country's activities relating to latent tuberculosis infection. …

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