Missed Opportunities in the Prevention and Diagnosis of Pediatric Tuberculosis; a scope review

Despite its ancient origins, tuberculosis (TB) remains a major public health problem. In the pediatric population, the prevention and diagnosis of TB is considered a major challenge. For this reason, this scoping review will be conducted in order to systematically map the research carried out in this area and identify potential barriers, delays and missed opportunities in the prevention and diagnosis of childhood TB.

This study will be prepared in accordance with the PRISMA extension for scoping reviews published in 2018.

To achieve the objective proposed in the study, the following guiding question was defined: What is the scientific evidence on missed opportunities in the prevention and diagnosis of tuberculosis in pediatric patients? Following the acronym PCC, the population (P) is composed of children under 18 years with TB disease, concept (C) refers to missed opportunities such as; contact with adults with TB and failure in LTBI investigation or treatment and context (C) is defined as diagnosis of TB disease.

We will carry out a systematic search in the databases; VHL, Medline via PubMed, Cochrane, Scopus and Web of Science. The following descriptors will be used: “tuberculosis”, “missed opportunities” “diagnosis”, “prevention”, “case finding” “gap”.

The final quest in each base is presented below:

VHL: (diagnosis OR diagnosis OR diagnosis OR "Oportunidade Perdida" OR "Oportunidades Perdidas" OR "Missed Opportunity" OR "Missed Opportunities") AND ("Prevenção de Diseases" OR "Disease Prevention" OR "Prevención de Enfermedades" OR "Prévention " CUMED" OR "BIGG" OR "WHOLIS" OR "MULTIMEDIA" OR "BDENF" OR "LIPECS" OR "SES-SP" OR "colecionaSUS" OR "PAHO" OR "SOF" OR "campusvirtualsp_brasil" OR "PAHOIRIS" OR " SMS-SP"))

Medline via PubMed: (Diagnosis OR "Missed Opportunity" OR "Missed Opportunities") AND ("Disease Prevention" OR Prevention) AND (Tuberculosis) AND (Pediatrics OR Child).

Cochrane: (Diagnosis OR "Missed Opportunity" OR "Missed Opportunities") AND ("Disease Prevention" OR Prevention) AND (Tuberculosis) AND (Pediatrics OR Child

Scopus: (Diagnosis OR "Missed Opportunity" OR "Missed Opportunities") AND ("Disease Prevention" OR Prevention) AND (Tuberculosis) AND (Pediatrics OR Child)

Web of Science: (Diagnosis OR "Missed Opportunity" OR "Missed Opportunities") AND ("Disease Prevention" OR Prevention) AND (Tuberculosis) AND (Pediatrics OR Child)

The inclusion criteria used will be: original published observational studies that included a pediatric population (0 to 18 years old) with TB disease that address missed opportunities in the prevention and diagnosis of the disease. Studies with quantitative data will be included to support the identification of missed opportunities for the diagnosis of tuberculosis. There will be no restriction related to languages or date of publication.

Studies such as reports, abstracts, guidelines, letters to the editor and review articles will be excluded. Articles that include an adult population or a population with latent tuberculosis will also be discarded.

The selection of studies will be performed after reading the title, abstract or in full, if necessary, for analysis by two independent reviewers. In case of doubt or disagreement, a third reviewer will participate in the analysis. The guiding question will direct the selection process and all articles that use a lost opportunity variable for the diagnosis of tuberculosis in children will be identified.

Then, all selected studies will be read in full for extraction. The reviewers will aim to identify and establish variables presented in the literature as missed opportunities for the diagnosis of tuberculosis and as the context in which the diagnosis was subsequently performed.

For data summarization, the articles will be tabulated, according to the information defined by PRISMA: author, year, number of studied population included, missed opportunity, frequency of cases in each of the defined missed opportunities, statistical analysis if present, evaluation of quality and completion of each study.