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Open Access Research article

Operational challenges in managing Isoniazid Preventive Therapy in child contacts: A high-burden setting perspective

Susan S van Wyk1*, Anthony J Reid3, Anna M Mandalakas12, Donald A Enarson4, Nulda Beyers1, Julie Morrison1 and Anneke C Hesseling1

Author Affiliations

1 Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa

2 Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA

3 Medecins Sans Frontieres, Operational Centre Brussels, Belgium

4 International Union Against Tuberculosis and Lung Disease, Paris, France

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BMC Public Health 2011, 11:544  doi:10.1186/1471-2458-11-544

Published: 8 July 2011



The study was conducted at a high TB-HIV burden primary health community clinic in Cape Town, South Africa. We describe the management of children under five years of age in household contact with a smear and/or culture-positive adult TB case.


This study was a record review of routinely-collected programme data.


A total of 1094 adult TB case folders were reviewed. From all identified contacts, 149 children should have received IPT based on local guidelines; in only 2/149 IPT was initiated. Management of child contacts of sputum smear and/or culture-positive compared to sputum-negative TB patients were similar.


IPT delivery to children remains an operational challenge, especially in high TB-HIV burden communities. A tool to improve IPT management and targeting sputum smear and/or culture-positive TB child contacts may overcome some of these challenges and should be developed and piloted in such settings.