Missed opportunities for screening child contacts of smear-positive tuberculosis in Zambia, a high-prevalence setting

OBJECTIVE: To evaluate whether contact screening recommendations for child household contacts of adult smear-positive tuberculosis (TB) cases were implemented in Lusaka, Zambia. METHODS: A cross-sectional survey of smear-positive adults receiving anti-tuberculosis treatment was conducted. The main outcomes were proportions of TB patients with under-five children who were aware, informed and/or had a child screened and/or commenced on isoniazid (INH). RESULTS: Of 371 TB patients (median age 33 years, 70% males), 259 (70%) lived with a child aged <15 years, of whom 48% (177) were aged <5 years. Overall, 32% (n = 119) were aware about child contact screening; 49% were informed by community agents vs. 38% by health care providers. Of the 259 TB patients with children, 32% (n = 84) were aware of contact screening, 32% (56/177) of whom had children aged <5 years. Of the 92/259 (36%) who were asked to have their children screened by the health care provider, 19% (49) complied. Of 177 eligible children, 11% (n = 20) were commenced on INH. Patients were more likely to comply when informed by the health care provider vs. the community agent. CONCLUSION: Screening of child contacts of adult smear-positive TB patients in areas with a large burden of adult disease is not routinely implemented. Interventions are required to ensure compliance with contact screening recommendations.