Ending neglect: providing effective childhood tuberculosis training for health care workers in Tanzania

SETTING: Health care facilities in Dar es Salaam, Pwani, and Arusha, Tanzania. OBJECTIVE: To assess health care worker (HCW) knowledge and practices 1 year after specialized training in childhood tuberculosis (TB). DESIGN: Using a standardized survey, we interviewed a convenience sample of HCWs providing both general and specialized care to children. RESULTS: We interviewed 117 HCWs in TB clinics, maternal and child health clinics, human immunodeficiency virus (HIV) clinics, out-patient departments, and pediatric in-patient wards at 12 facilities. A total of 81 HCWs (62% of nurses, 74% of clinicians) reported having attended the national childhood TB training course. Most HCWs responded correctly to questions on childhood TB diagnosis, treatment, and TB-HIV co-management, regardless of training history. Most HCWs reported that they routinely obtain chest radiographs, HIV testing, and a TB contact history when evaluating children for TB. Less than half of HCWs reported routinely obtaining sputum for mycobacterial culture or performing a tuberculin skin test. Three times as many trained as untrained HCWs reported having ever prescribed isoniazid preventive therapy (IPT) to a child (P < 0.05). CONCLUSION: In general, levels of childhood TB knowledge were high and practices were in accordance with national guidance. Specific gaps in diagnosis, treatment and use of IPT were identified for future focused training.