Factors associated with completion of 6 months of isoniazid preventive therapy among under-five children exposed to tuberculosis patients in Blantyre, Malawi

Abstract

Background: The World Health Organization recommends 6 months of isoniazid preventive therapy (IPT) to children who have been exposed to tuberculosis (TB) patients to prevent active TB. Although IPT is an efficacious intervention, it is underutilised.
Aim: The aim of this study was to examine factors associated with the completion of IPT among children under 5 years who have been exposed to TB patients.
Setting: This was a secondary data analysis; the primary study was conducted in Blantyre, Malawi.
Methods: This study was a secondary analysis of a randomised controlled trial with follow-up at 3 months and 6 months. Univariable and multivariable logistic regression models were used to identify factors associated with the completion of IPT.
Results: One hundred and twenty-eight children were included, of whom 58 (45.3%) completed IPT. Index patient human immunodeficiency virus (HIV)-positive status (adjusted odds ratio [aOR] = 0.39, 95% confidence interval [CI]: 0.16–0.94) and longer distance (> 5 km) (aOR = 0.25, 95% CI: 0.07–0.89) were associated with lower IPT completion. Wealth status, household health-seeking decision maker and type of contact tracing were associated with higher IPT completion, with aOR = 3.42 (95% CI: 1.19–9.88) for children coming from households of high wealth status, aOR = 3.17 (95% CI: 1.19–8.42) in which the health-seeking decision maker was the parent compared to other guardians, and aOR = 3.13 (95% CI: 1.25–7.84) for children who were identified through patient-conducted tracing compared to routine contact tracing.
Conclusion: Human immunodeficiency virus status, wealth status, household health-seeking decision maker, proximity to health facility and type of contact tracing are key determinants of IPT completion among children.
Contribution: This study provides valuable insights into the factors that affect the completion of IPT. By addressing these factors, completion of IPT can be improved, thereby preventing TB among children.