Adherence to and factors moderating the implementation of childhood TB contact tracing guidelines in selected facilities in Ndola District, Zambia: a cross-sectional study

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. 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. 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. 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.