title: Barriers to the diagnosis of childhood tuberculosis: a qualitative study.
abstract: METHODS
  In 2012, Peru's National Tuberculosis Program (NTP) reported that children aged 0-14 years accounted for 7.9% of the country's tuberculosis (TB) incidence. This figure is likely an underestimate due to suboptimal diagnosis of childhood TB.
  
  
  OBJECTIVE
  To identify barriers to childhood TB diagnosis in Lima, Peru.
  
  
  METHODS
  Using semi-structured guides, moderators conducted in-depth interviews with four NTP administrators and five pulmonologists specializing in TB and 10 focus groups with 53 primary care providers, community health workers (CHWs), and parents and/or guardians of pediatric TB patients. Two authors independently performed inductive thematic analysis and identified emerging themes.
  
  
  RESULTS
  Participants identified five barriers to childhood TB diagnosis: ignorance and stigma among the community, insufficient contact investigation, limited access to diagnostic tests, inadequately trained health center staff, and provider shortages.
  
  
  CONCLUSIONS
  Recent efforts to increase childhood TB detection have centered on the development of new technologies. However, our findings demonstrate that many diagnostic barriers are rooted in socio-economic and health system problems. Potential solutions include implementing multimedia campaigns and community education to reduce ignorance and stigma, prioritizing contact investigation for high-risk households, and training primary care providers and CHWs to recognize and evaluate childhood TB.
authors.affiliation: Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Chiang
authors.affiliation: Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: S
authors.initials: S
authors.lastname: Roche
authors.affiliation: Socios En Salud Sucursal Peru (Partners In Health), Lima, Peru.
authors.forename: C
authors.initials: C
authors.lastname: Contreras
authors.affiliation: Estrategia Sanitaria Nacional de Prevención y Control de Tuberculosis, Ministerio de Salud, Lima, Peru.
authors.forename: V
authors.initials: V
authors.lastname: Alarcón
authors.affiliation: Instituto Nacional de Salud del Niño, Lima, Peru.
authors.forename: H
authors.initials: H
authors.lastname: Del Castillo
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Socios En Salud Sucursal Peru (Partners In Health), Lima, Peru; Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Becerra
authors.affiliation: Socios En Salud Sucursal Peru (Partners In Health), Lima, Peru.
authors.forename: L
authors.initials: L
authors.lastname: Lecca
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D010290:Parents; D010568:Peru / Q000453:epidemiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology