Primary health care staff's perceptions of childhood tuberculosis: a qualitative study from Tanzania

We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis.Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely differential diagnosis. Long duration and severe signs of disease together with known exposure to tuberculosis were decisive for the staff to suspect tuberculosis in children and refer them to hospital. None of the staff felt equipped to identify cases of childhood tuberculosis and they experienced lack of knowledge, applicable tools and guidelines as the main challenges. They expressed the need for more training, supervision and referral feedback to improving case identification.Inadequate awareness of the burden of childhood tuberculosis, limited knowledge of the wide spectrum of clinical presentation and lack of clinical decision support strategies is detrimental to the health staff's central responsibility of suspecting and referring children with tuberculosis especially in the early disease stages. Activities to improve case identification should focus on skills required by primary health care staff to fulfil their responsibility and reflect primary health care level capacities and challenges.Tuberculosis (TB) in children is a serious condition, and in endemic regions TB is a likely cause of death among children with symptoms of respiratory infection [1]. The relative proportion of TB cases occurring in children is found to vary significantly between countries [2], and Marais et al. have estimated that children are likely to represent 15-20% of the disease burden in areas where the TB epidemic is poorly controlled [1]. Diagnosing TB in children is complex and challenged by investigations methods being inaccessible in resource-poor areas [1,3-5].