Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study
Abstract Background The current prevalence of tuberculosis (TB) in Zambian children is well above the World Health Organization regional average indicating missed opportunities for diagnosis and treatment. One of the key strategies aimed at ending the global TB epidemic by 2030 is contact investigat...
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| Format: | Article |
| Language: | English |
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Springer
2025-04-01
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| Series: | Discover Public Health |
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| Online Access: | https://doi.org/10.1186/s12982-025-00497-7 |
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| author | Elizabeth Kashindi Patricia Maritim Adam Silumbwe Joseph M. Zulu Gershom Chongwe Patrick Kaonga Choolwe Jacobs |
| author_facet | Elizabeth Kashindi Patricia Maritim Adam Silumbwe Joseph M. Zulu Gershom Chongwe Patrick Kaonga Choolwe Jacobs |
| author_sort | Elizabeth Kashindi |
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| description | Abstract Background The current prevalence of tuberculosis (TB) in Zambian children is well above the World Health Organization regional average indicating missed opportunities for diagnosis and treatment. One of the key strategies aimed at ending the global TB epidemic by 2030 is contact investigation, which identifies children exposed to TB based on established guidelines. However, few studies examine healthcare provider experiences with childhood TB guidelines. We sought to determine healthcare providers’ adherence to and moderators of the implementation of childhood TB contact investigation guidelines in selected facilities in Ndola District, Zambia. Methods This was a cross-sectional study conducted between April and June 2023, involving observations and structured questionnaires administered to 42 healthcare providers across nineteen (19) selected facilities. The Yamane and complete enumeration sampling strategies were used for selecting facilities and participants respectively. A multivariable logistic regression with robust standard errors was used to control for confounding, potential clustering and determining the variables associated with adherence at a 95% confidence level. All statistical analyses were done with the STATA 15.0 software. Results A total of 42 healthcare providers were included in the final analysis of which: 31 (73.8%) were women and 11 (26.2%) were men with a median age of 37 years (Interquartile Range (IQR): 27, 58). Eighteen of forty-two (42.9%) healthcare providers were found to adhere to contact investigation guidelines. Moderators of contact investigation guidelines were related to the provider and organizational context. With each additional year in a healthcare provider’s age, there was a corresponding 1.12 increase (AOR 1.12, 95% CI 1.03–1.22 P = 0.006) in adherence. Furthermore, healthcare providers in facilities with alternative policy manuals were 98% less likely (AOR 0.02, 95% CI 0.002, 0.147 P ≤ 0.001) to report high adherence to the guidelines. Conclusion There is sub-optimal adherence to national childhood TB contact investigation guidelines among healthcare providers in Ndola. This suggests need for targeted trainings and orientation to guidelines as well as increased guidelines accessibility at facility level. |
| format | Article |
| id | doaj-art-2164aa8a3ec544719f214fd1a2d805b0 |
| institution | OA Journals |
| issn | 3005-0774 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Springer |
| record_format | Article |
| series | Discover Public Health |
| spelling | doaj-art-2164aa8a3ec544719f214fd1a2d805b02025-08-20T02:27:50ZengSpringerDiscover Public Health3005-07742025-04-0122111310.1186/s12982-025-00497-7Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional studyElizabeth Kashindi0Patricia Maritim1Adam Silumbwe2Joseph M. Zulu3Gershom Chongwe4Patrick Kaonga5Choolwe Jacobs6Department of Epidemiology and Biostatistics, School of Public Health, University of ZambiaDepartment of Health Policy and Management, School of Public Health, University of ZambiaDepartment of Health Policy and Management, School of Public Health, University of ZambiaDepartment of Health Policy and Management, School of Public Health, University of ZambiaDepartment of Epidemiology and Biostatistics, School of Public Health, University of ZambiaDepartment of Epidemiology and Biostatistics, School of Public Health, University of ZambiaDepartment of Epidemiology and Biostatistics, School of Public Health, University of ZambiaAbstract Background The current prevalence of tuberculosis (TB) in Zambian children is well above the World Health Organization regional average indicating missed opportunities for diagnosis and treatment. One of the key strategies aimed at ending the global TB epidemic by 2030 is contact investigation, which identifies children exposed to TB based on established guidelines. However, few studies examine healthcare provider experiences with childhood TB guidelines. We sought to determine healthcare providers’ adherence to and moderators of the implementation of childhood TB contact investigation guidelines in selected facilities in Ndola District, Zambia. Methods This was a cross-sectional study conducted between April and June 2023, involving observations and structured questionnaires administered to 42 healthcare providers across nineteen (19) selected facilities. The Yamane and complete enumeration sampling strategies were used for selecting facilities and participants respectively. A multivariable logistic regression with robust standard errors was used to control for confounding, potential clustering and determining the variables associated with adherence at a 95% confidence level. All statistical analyses were done with the STATA 15.0 software. Results A total of 42 healthcare providers were included in the final analysis of which: 31 (73.8%) were women and 11 (26.2%) were men with a median age of 37 years (Interquartile Range (IQR): 27, 58). Eighteen of forty-two (42.9%) healthcare providers were found to adhere to contact investigation guidelines. Moderators of contact investigation guidelines were related to the provider and organizational context. With each additional year in a healthcare provider’s age, there was a corresponding 1.12 increase (AOR 1.12, 95% CI 1.03–1.22 P = 0.006) in adherence. Furthermore, healthcare providers in facilities with alternative policy manuals were 98% less likely (AOR 0.02, 95% CI 0.002, 0.147 P ≤ 0.001) to report high adherence to the guidelines. Conclusion There is sub-optimal adherence to national childhood TB contact investigation guidelines among healthcare providers in Ndola. This suggests need for targeted trainings and orientation to guidelines as well as increased guidelines accessibility at facility level.https://doi.org/10.1186/s12982-025-00497-7Contact investigationFidelityAdherenceModeratorsNational guidelinesImplementation |
| spellingShingle | Elizabeth Kashindi Patricia Maritim Adam Silumbwe Joseph M. Zulu Gershom Chongwe Patrick Kaonga Choolwe Jacobs Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study Discover Public Health Contact investigation Fidelity Adherence Moderators National guidelines Implementation |
| title | Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study |
| title_full | Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study |
| title_fullStr | Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study |
| title_full_unstemmed | Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study |
| title_short | Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study |
| title_sort | adherence to and factors moderating the implementation of childhood tb contact tracing guidelines in selected facilities in ndola district zambia a cross sectional study |
| topic | Contact investigation Fidelity Adherence Moderators National guidelines Implementation |
| url | https://doi.org/10.1186/s12982-025-00497-7 |
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