|dc.description.abstract||Background: Paediatric Tuberculosis
(TB) is rapidly becoming a major public
health concern among the urban poor.
Though contacts' tracing and Isoniazid
Prophylaxis Therapy (lPT) is an effective
prevention strategy, its benefits have
not been realized in many resource poor
settings. Barriers to its uptake have not
been fully elucidated.
Objectives: To evaluate the challenges
that fraught the implementation of' contact
tracing and IPT, as a TB prevention
strategy in children in household contact
with adults with TB from informal
settlements in Nairobi, Kenya.
Metbodology: A prospective longitudinal
multicenter cohort study was done,
where 366 recently diagnosed TB smear
positive source cases were asked to enroll
their child contacts for IPT. Consent was
sought. Structured standard questionnaire
was used to get information on source
case TB treatment, socio-demographics,
TB knowledge and perceptions. Baseline
screening was done to exclude those
with TB and/or other chronic illnesses.
Contacts were then put on daily isoniazid
for 6 months and followed up monthly for
one year for new TB disease. Adherence,
safety and challenges were monitored.
Focused group discussions and key
informant interviews were used to provide
Results: All the 366 source cases
interviewed were on first line anti- TB
treatment. IPT acceptability was 87.3%. A
total of 428 child contacts were screened, but
14(3.2%) had TB disease hence excluded.
Compliance rates were 93% (95% CI
90.1 - 96.2%) and 85% (95% CI 80.2%-
88%) after 1'1and 6th months respectively.
Challenges reported included; side
effects in 22%, programmatic concerns
in 86%, drug related issues in 70.1 %,
and various health system challenges.
The leading programmatic challenge was
too many hospital visits (65.2%) and the
drug related challenge was difficulty in
administering tablets to children (44.3%).
IPT completion rate was 368 out of 414
(88.8%). By endpoint, IPT failure was
documented in 6( 1.6%), hence the relative
risk of new TB disease in contacts on IPT
was 0.49 (95% CI 0.21 -0.86).
Conclusion: IPTwas an effective and safe
child TB prevention strategy in informal
settlements, but it's implementation
had been hampered by relatively low
acceptability, sub-optimal adherence,
programmatic challenges, and high
defaulting rates and by limited benefits