What is the feasibility and acceptability of stool sampling and testing for childhood tuberculosis diagnosis? A qualitative study in The Gambia.

Abstract

To explore the feasibility and acceptability of stool sampling and testing for childhood tuberculosis (TB) diagnosis among adolescents, child caregivers and healthcare workers (HCWs) who participated in a diagnostic accuracy study and among National Leprosy and TB Control Programme (NLTP) officials in The Gambia. This was a qualitative cross-sectional study that used semi-structured interviews. Braun and Clarke's thematic analysis framework guided our analysis. The study was conducted in The Gambia at the TB clinic of the Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine. We purposively sampled and interviewed 27 participants, including adolescents and caregivers of children who participated in and provided stool samples for the diagnostic accuracy study of the Childhood TB Research in West Africa (CHIRWA-2), HCWs involved in the CHIRWA-2 study, and NLTP officials responsible for policy and programme implementation in The Gambia. HCWs and NLTP officials described stool sampling and testing as feasible for TB diagnosis, given the ease of collection and the potential to integrate them into existing workflows. However, availability and sustainable supply of resources are required for successful implementation. Caregivers were willing to provide stool samples for TB diagnosis, although they were surprised by the use of stool for diagnosing TB. Adolescents, on the other hand, felt embarrassed about providing a stool sample. HCWs preferred stool samples over sputum samples because stool sampling was easier and less time-consuming, and further suggested sustained logistics support, adequate community sensitisation and regular incentives for HCWs as necessary for successful implementation. Participants perceived that using stool sampling and testing for TB diagnosis in children is feasible and acceptable in Gambia. Its integration into routine health service delivery requires careful consideration of the available resources.