Bulletin of the World Health Organization

Management of children exposed to Mycobacterium tuberculosis: a public health evaluation in West Java, Indonesia

Merrin E Rutherford, Rovina Ruslami, Melissa Anselmo, Bachti Alisjahbana, Neti Yulianti, Hedy Sampurno, Reinout van Crevel & Philip C Hill

Volume 91, Number 12, December 2013, 932-941A

Table 1. Performance of system for managing child contacts of tuberculosis patients, community lung clinic, Bandung, Indonesia, 2009–2012

Performance parameter Indicator Target performance,a %   Participants, n   Observed performance, a% (95% CI) Gap between target and observed performance,a %
Screening compliance Proportion of child contacts of tuberculosis patients who were eligible for tuberculosis disease screening and who returned to the clinic for screening > 90b 437 8 (5.5–10.5) 82
Initiation of isoniazid preventive therapy Proportion of child contacts younger than 5 years who were eligible for isoniazid preventive therapy and who received therapy > 90b 15 40 (15.2–61.8) 50
Accuracy of tuberculosis disease diagnosis Agreement between attending paediatrician and external paediatric tuberculosis expert on disease diagnosis kappa >70c 118 kappa 6.0 (1.0–11.0) 64
Proportion of child contacts with a latent tuberculosis infection who were diagnosed with tuberculosis disease using the Indonesian Paediatric Scoring System 0 41 100 (NA) 100
Adherence to isoniazid preventive therapy Proportion of children for whom three or more prescriptions were collected over a 6-month period > 80b 82 26 (16.5–35.5) 54
Primary caregivers’ knowledge Proportion of caregivers with adequate knowledge of child tuberculosis disease screening > 80 10 100 (NA) 0
Proportion of caregivers with adequate knowledge of isoniazid preventive therapy > 80 10 10 (0–28.6) 70
Primary caregivers’ acceptance Primary caregivers’ acceptance of tuberculosis disease screening No barriers identified 10 4 barriers identified 4 barriers
Primary caregivers’ acceptance of isoniazid preventive therapy No barriers identified 10 4 barriers identified 4 barriers
Medical staff’s knowledge Proportion of staff who answered correctly at least 75% of questions on knowledge of child contact management 75d 34 29 (13.8–44.2) 46
Medical staff’s attitude Proportion of staff who answered correctly at least 75% of questions on attitudes towards child contact management 75d 34 44 (27.3–60.7) 31
Medical staff’s acceptance Medical staff’s acceptance of tuberculosis disease screening No barriers identified 10 2 barriers identified 2 barriers
Medical staff’s acceptance of isoniazid preventive therapy No barriers identified 10 3 barriers identified 3 barriers
Cost Proportion of households whose screening costs exceeded 10% of monthly household incomee 0 149 50 (41.7–57.7) 50
Medication availability Days without a medication supply 0 daysf 1 0 days 0 days
Medication quality Supplier of medications compliant with WHO good manufacturing practice Yes 1 Yes no gap

CI, confidence interval; NA, not applicable, WHO, World Health Organization.

a All values are percentages except where otherwise noted.

b Targets from the Centers for Disease Control and Prevention, Atlanta, United States of America.13

c Based on concordance between two paediatric expert reviewers.14

d Standard pass rate for medical assessments.

e Based on a definition of catastrophic health shock from the literature.15

f Based on Global Drug Facility and principles of the DOTS strategy.16