Prevalence and Factors Associated with Initiation of Isoniazid Preventive Therapy among Children below Five Years Living with Persons Diagnosed with Pulmonary Tuberculosis in Kisumu County, Kenya

Abstract

Kenya is among the 10 out of 22 countries heavily burdened with Tuberculosis (TB) worldwide with an estimated prevalence of 266 per 100,000. Kisumu County is a TB and Human Immunodeficiency Virus (HIV) endemic zone with a prevalence of 208-306 per 100,000 and 19.3% respectively. The WHO, 2008 policy document advocated for initiation of Isoniazid Preventive Therapy (IPT) among children aged below 5 years who are household contacts of sputum positive pulmonary tuberculosis (PTB) persons. IPT prevents progression from latent TB to active TB disease. Despite the adoption and scale up of IPT policy in Kenya, initiation of children aged below 5 years in Kisumu County remains low hampering END TB elimination and control strategies. Moreover, there is paucity of data exploring the levels of IPT initiation and associated factors among children aged below 5 years in this setting. This study was conducted to determine prevalence of IPT initiation and factors associated with IPT initiation among children aged below 5 years who live in households with sputum positive PTB persons. The study was carried out at Jaramogi Oginga Odinga Teaching and Referral hospital, Kisumu County hospital, Lumumba, Migosi, and Rabuor sub-county hospitals. The research applied the cross-sectional study design. Consequently, purposive sampling was used to recruit sputum positive PTB persons (n=175) and TB clinic staff (n=35) to whom structured questionnaires were administered. Fisher’s exact test was used to determine the association between categorical variables and initiation of IPT. Generalized linear model (log, negative binomial) was used to estimate the prevalence rate ratio of IPT Initiation. The α level of significance was set at p<0.05 and data was analyzed using STATA (version 14.1). The mean age of respondents was [33±SD 11.2]. Prevalence of IPT initiation was established as [70.2%; 95% C.I (63.0-76.6)] with the female respondents more likely to initiate their children on IPT [72.6%; 95% C.I (67.7-80.7)]. Multivariate prevalence rate ratio showed that respondents aged less than 25 years [aPR=1.43; 95% C.I (1.13-1.83)] were more likely to initiate the children on IPT than those aged >40 years. Respondents who resided in urban areas [aPR=1.56; 95% C.I (1.22-2.00)] and peri-urban areas [aPR=1.63; 95% C.I (1.43-1.87)] were more likely to initiate children on IPT compared to those in rural areas. Respondents with more than 5 persons in the household [aPR=2.02; 95% C.I (1.26-3.23)] were more likely to initiate children on IPT compared to those with 1-2 persons in the households. Respondents who had an average contact of 3-6 hours during the day [aPR=1.74; 95% C.I (1.11-2.73)] and >6 hours contact [aPR=1.66; 95% C.I (1.06-2.58)] were more likely to initiate the children on IPT compared to those with less than 3 hours contact time. Respondents who slept with the children in the same room [aPR=1.50; 95% C. I (1.22-1.85)] were more likely to initiate the children on IPT compared to those who did not sleep with them in the same room. The Ministry of health (MOH) and collaborates should advocate for health promotion activities unlimited to sensitization among sputum positive PTB persons with children aged below 5 years to help bolster IPT initiation in rural areas. Nonetheless, further studies need to examine the correlates of IPT initiation and predictors of missed opportunity to IPT initiation among children aged below 5 years sputum positive PTB persons.