Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2023; 11(1): 104-115
Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.104
Completion of 6-mo isoniazid preventive treatment among eligible under six children: A cross-sectional study, Lagos, Nigeria
Victor Abiola Adepoju, Ademola Adelekan, Aderonke Agbaje, Femi Quaitey, Tobi Ademola-Kay, Ann Uduak Udoekpo, Olusola Daniel Sokoya
Victor Abiola Adepoju, Department of HIV and Infectious Diseases, Jhpiego Nigeria, Federal Capital Territory, Abuja 900918, Nigeria
Ademola Adelekan, Department of Research, Bluegate Research Institute, Ibadan 211271, Oyo State, Nigeria
Aderonke Agbaje, Clinical Services, Institute of Human Virology of Nigeria, Abuja 900918, Nigeria
Femi Quaitey, Department of HIV and Infectious Diseases, Jhpiego Nigeria, Uyo 520108, AkwaIbom, Nigeria
Tobi Ademola-Kay, Adolescent and Youth Care, Youth Development and Empowerment Initiative, Lagos 23401, Nigeria
Ann Uduak Udoekpo, Monitoring and Evaluation, Jhpiego Nigeria, Uyo 520108, AkwaIbom, Nigeria
Olusola Daniel Sokoya, Lagos State Tuberculosis, Buruli Ulcer and Leprosy Control Program, Ikeja 100001, Lagos, Nigeria
Author contributions: Adepoju VA and Adelekan A designed the study; Adepoju VA, Sokoya OD and Adelekan A drafted the manuscript; Agbaje A, Ademola-Kay T, Quaitey F, and Udoekpo A revised it critically for important intellectual content; Agbaje A, Quaitey F, Udoekpo A and Sokoya OD contributed to the analysis and interpretation of data; Adepoju VA is the corresponding author of this manuscript, gave final approval of the manuscript submitted.
Institutional review board statement: The study is a retrospective review and abstraction of data from register with no human subject involvement, hence ethical review was not indicated. Informed consent statement: Informed consent was taken from mothers of children involved in this retrospective study. Permission was also received from the Lagos State TB, Buruli Ulcer and Leprosy Control Program.
Informed consent statement: Verbal consent was taken from the parent/caregiver of the children before placing them on INH.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author on request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Victor Abiola Adepoju, MBChB, MSc, Doctor, Senior Editor, Department of HIV and Infectious Diseases, Jhpiego Nigeria, Federal Capital Territory, Plot 971, Rueben Okoya Crescent, Wuye, Abuja 900918, Nigeria. schrodinga05@yahoo.com
Received: October 6, 2022
Peer-review started: October 6, 2022
First decision: October 27, 2022
Revised: November 15, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 6, 2023
Processing time: 90 Days and 19.6 Hours
Abstract
BACKGROUND

Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic. Tuberculosis annual risk for children could be as high as 4% particularly in high tuberculosis (TB) prevalent communities. Isoniazid (INH) Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.

AIM

To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos, Nigeria.

METHODS

This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children < 6 years old enrolled for INH across 32 private hospitals in Lagos, Nigeria. The study took place between July and September 2020. Data was collected on independent variables (age, gender, type of facility, TB screening, dose and weight) and outcome variables (INH outcome and proportion lost to follow up across months 1-6 of INH treatment).

RESULTS

About 53.8% of the participants were female, 95.4% were screened for TB and none was diagnosed of having TB. The participants’ age ranged from 1 to 72 mo with a mean of 36.01 ± 19.67 mo, and 40.2% were between the ages of 1-24 mo. Only 155 (59.2%) of the 262 participants initiated on INH completed the six-month treatment. Cumulatively, 107 (41.0%) children were lost to follow-up at the end of the sixth month. Of the cumulative 107 loss to follow-up while on INH, largest drop-offs were reported at the end of month 2, 52 (49%) followed by 20 (19%), 17 (16%), 11 (10.2%) and 7 (6.5%) at months 3, 4, 5 and 6 respectively. The analysis showed that there was no significant association between age, gender, type of facility and completion of INH treatment (P > 0.005).

CONCLUSION

This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos, Nigeria. The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment.

Keywords: Isoniazid; Child; Tuberculosis; Treatment Outcome; Completion; Latent tuberculosis; Dosage

Core Tip: Isoniazid (INH) completion rate among children in Nigeria was suboptimal in this programmatic cohort. The chi-square analysis revealed that age, gender, and type of facility were not determinants of the treatment completion of INH recorded among eligible children initiated in Lagos, Nigeria. The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-day INH calendar that would facilitate reminder and early engagement of children on INH and their caregivers in care and across the entire period of treatment. Targeted interventions such as community initiation and monitoring of INH by healthcare workers, and rapid scale up of shorter tuberculosis preventive therapy regimen are needed to address these drop-offs along the childhood INH cascade. Future studies should therefore qualitatively explore the reasons why some children did not complete the INH.