Correlates of Isoniazid Preventive Therapy Failure in Child Household Contacts with Infectious Tuberculosis in High Burden Settings in Nairobi, Kenya – a Cohort Study
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Date
2017
Authors
Okwara, Florence Nafula
Oyore, John Paul
Were, Fred Nabwire
Gwer, Samson
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Infectious Diseases
Abstract
Background: Sub-Saharan Africa continues to document high pediatric tuberculosis (TB) burden, especially among
the urban poor. One recommended preventive strategy involves tracking and isoniazid preventive therapy (IPT) for
children under 5 years in close contact with infectious TB. However, sub-optimal effectiveness has been documented
in diverse settings. We conducted a study to elucidate correlates to IPT strategy failure in children below 5 years in
high burden settings.
Methods: A prospective longitudinal cohort study was done in informal settlings in Nairobi, where children
under 5 years in household contact with recently diagnosed smear positive TB adults were enrolled. Consent
was sought. Structured questionnaires administered sought information on index case treatment, socio-demographics
and TB knowledge. Contacts underwent baseline clinical screening exclude TB and/or pre-existing chronic conditions.
Contacts were then put on daily isoniazid for 6 months and monitored for new TB disease, compliance and side
effects. Follow-up continued for another 6 months.
Results: At baseline, 428 contacts were screened, and 14(3.2%) had evidence of TB disease, hence excluded. Of 414
contacts put on IPT, 368 (88.8%) completed the 1 year follow-up. Operational challenges were reported by 258(70%)
households, while 82(22%) reported side effects. Good compliance was documented in 89% (CI:80.2–96.2).
By endpoint, 6(1.6%) contacts developed evidence of new TB disease and required definitive anti-tuberculosis
therapy. The main factor associated with IPT failure was under-nutrition of contacts (p = 0.023).
Conclusion: Under-nutrition was associated with IPT failure for child contacts below 5 years in high burden,
resource limited settings. IPT effectiveness could be optimized through nutrition support of contacts.
Description
Article
Keywords
Tuberculosis, Children, Isoniazid, Prevention, Failure
Citation
Okwara, F. N., Oyore, J. P., Were, F. N., & Gwer, S. (2017). Correlates of isoniazid preventive therapy failure in child household contacts with infectious tuberculosis in high burden settings in Nairobi, Kenya–a cohort study. BMC infectious diseases, 17(1), 1-11.