Barriers to initiating tuberculosis treatment in sub-Saharan Africa: a systematic review focused on children and youth.


Journal Article (Review)

BACKGROUND: Tuberculosis (TB) is the deadliest infectious disease globally, with 10.4 million people infected and more than 1.8 million deaths in 2015. TB is a preventable, treatable, and curable disease, yet there are numerous barriers to initiating treatment. These barriers to treatment are exacerbated in low-resource settings and may be compounded by factors related to childhood. OBJECTIVE: Timely initiation of tuberculosis (TB) treatment is critical to reducing disease transmission and improving patient outcomes. The aim of this paper is to describe patient- and system-level barriers to TB treatment initiation specifically for children and youth in sub-Saharan Africa through systematic review of the literature. DESIGN: This review was conducted in October 2015 in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Six databases were searched to identify studies where primary or secondary objectives were related to barriers to TB treatment initiation and which included children or youth 0-24 years of age. RESULTS: A total of 1490 manuscripts met screening criteria; 152 met criteria for full-text review and 47 for analysis. Patient-level barriers included limited knowledge, attitudes and beliefs regarding TB, and economic burdens. System-level barriers included centralization of services, health system delays, and geographical access to healthcare. Of the 47 studies included, 7 evaluated cost, 19 health-seeking behaviors, and 29 health system infrastructure. Only 4 studies primarily assessed pediatric cohorts yet all 47 studies were inclusive of children. CONCLUSIONS: Recognizing and removing barriers to treatment initiation for pediatric TB in sub-Saharan Africa are critical. Both patient- and system-level barriers must be better researched in order to improve patient outcomes.

Full Text

Duke Authors

Cited Authors

  • Sullivan, BJ; Esmaili, BE; Cunningham, CK

Published Date

  • 2017

Published In

Volume / Issue

  • 10 / 1

Start / End Page

  • 1290317 -

PubMed ID

  • 28598771

Pubmed Central ID

  • 28598771

Electronic International Standard Serial Number (EISSN)

  • 1654-9880

Digital Object Identifier (DOI)

  • 10.1080/16549716.2017.1290317


  • eng

Conference Location

  • United States