Initiation of Isoniazid Preventive Therapy in Under- Five Children: A Cross-Sectional Study in Zambia

Abstract

Background: Tuberculosis (TB) is a preventable disease among children exposed to infection. Despite the World Health Organization's (WHO) recommendation for Isoniazid (INH) preventive therapy, TB remains prevalent, with 1.1 million global cases reported in 2022. In Zambia, the TB incidence stands at 307 cases per 100,000 people, with stigma and delayed diagnosis posing significant barriers to prevention efforts. Objective: This study aimed to assess the prevalence of INH initiation and its associated factors among children under five attending four selected public health facilities in Zambia between 2019 and 2021. Method: A cross-sectional study was conducted with 421 participants from four public health facilities. Data were collected using a structured checklist and analysed using STATA 16.1 MP software. Binomial logistic regression was applied to obtain unadjusted and adjusted estimates at a 5% significance level. Results: Higher education was identified as a protective factor for INH initiation (AOR=0.41, 95% CI: 0.20–0.83, p=0.013). Religious practice significantly increased the likelihood of initiation (AOR=19.2, 95% CI: 2.50–147.7, p=0.005), whereas stigma reduced the odds of initiation (AOR=0.46, 95% CI: 0.24–0.91, p=0.025), underscoring its negative impact. Conclusion: INH initiation in children is significantly influenced by religious practices and community attitudes toward TB. To enhance uptake, targeted interventions should focus on addressing stigma, improving health education, and fostering community support for TB prevention efforts. However, the study is limited by its cross-sectional design, which does not establish causality, and the reliance on facility-based data, which may not capture broader community-level factors.