Missed opportunity for tuberculosis screening and prevention and the associated factors among child contacts in rural southwestern Uganda

Background: Tuberculosis (TB) treatment and control guidelines recommend that children that have had contact with persons with bacteriologically-confirmed TB should be screened. However, many children exposed to TB, especially in high-burden settings like Uganda remain unscreened. The extent of the missed opportunity for screening the exposed children in Ugandan rural settings remains largely unknown. This study aimed to determine the burden of missed opportunity for TB screening and prevention, and identify the associated factors in rural southwestern Uganda. Methods: We conducted a cross-sectional study in four high-volume TB treatment centers in Kanungu District, rural southwestern Uganda. Using consecutive sampling, we included children aged 0–14 years who were household contacts of bacteriologically-confirmed persons with TB. We defined a missed opportunity as not being screened for TB or not receiving preventive TB treatment despite being eligible. We used modified Poisson regression to identify factors associated with the missed opportunities. Results: Among 279 children enrolled from 79 households, 119 (42.7%) were aged <5 years, 103 (36.9%) were 5–10 years, and 57 (20.4%) were 11–14 years. Overall, 140 (50.2%) were not screened for TB. Among the 139 screened, 25 (18.0%) had a history of TB symptoms, and 6 (24%) were treated for TB. Of the 114 without symptoms, 60 were eligible for Isoniazid Preventive Therapy (IPT); however, 34 (56.7%) did not receive it. Overall, the prevalence of missed opportunities for screening and treatment was 69.2% (n=193; 95% CI: 63.5–74.3%). Factors independently associated with missed opportunity included living in a household below the poverty line (adjusted prevalence ratio [aPR]= 1.49, 95% CI:1.18–1.90), lack of formal education among index patients (aPR =1.26, 95% CI: 1.01–1.56), and being a contact aged <5 years (aPR=1.24, 95%CI:1.01 – 1.54). Conclusion: Our study revealed a high burden of missed opportunity for TB screening and prevention among child contacts in this rural setting, driven by socio-economic disadvantages, including household poverty, lack of formal education, and younger age for household TB contacts (<5 years). Interventions should target socio-economically disadvantaged households to improve access to TB screening and preventive care.