Two-phase study to optimise diagnosis and treatment for children and adolescents with tuberculosis in Namibia: knowledge, attitudes and practices of healthcare workers before and after the rollout of updated child and adolescent tuberculosis clinical guidelines.

INTRODUCTION: Child and adolescent tuberculosis (CATB) poses a significant global burden with an estimated 1.25 million diagnoses and 191 000 deaths annually, disproportionately higher than adult rates. Over half of CATB cases remain unreported, and burden increases are expected following the USA's tuberculosis (TB) aid withdrawal, particularly affecting high-burden countries including Namibia. Namibian children under the age of 15 years account for 10% of notified TB cases, with under-reporting suggesting higher actual morbidity and mortality. Through a multistakeholder process in 2024, Namibia's National Tuberculosis and Leprosy Programme (NTLP) updated its National Clinical Guidelines for CATB management. We aim to (1) assess baseline levels of CATB diagnosis and management knowledge and (2) evaluate post-training knowledge, attitudes and practices (KAP) with updated guidelines to identify gaps informing targeted interventions and policy refinement.

METHODS AND ANALYSIS: We plan to conduct a two-phase evaluation of healthcare workers' (HCWs) KAP regarding CATB diagnosis and management across Namibia. A collaborative team from Dartmouth, the University of Namibia (UNAM) and NTLP developed, piloted and refined a standardised assessment tool. 256 HCWs involved in all TB care levels are selected at three facilities per district across 16 districts stratified by TB burden (high, medium and low). Baseline data (KAP1) were collected before national training on updated guidelines, with follow-up assessment (KAP2) planned at 6 months post-training using the same procedures on a secure Research Electronic Data Capture (REDCap) platform. Descriptive analyses and regression models will summarise baseline KAP, while McNemar tests and paired t-tests will evaluate changes over time for participants who completed both KAP assessments.

ETHICS AND DISSEMINATION: Ethics approval was obtained from the UNAM and the Ministry of Health and Social Services (MoHSS). Written informed consent is obtained from all participants, protecting confidentiality and using secure data storage. Findings will be disseminated through Namibian MoHSS reports, conference presentations, peer-reviewed publications and policy briefs.