Table 1. Indicators of system performance in child TB case contact management.

Parameter	Indicator	Specific Study Details/Design
Screening and diagnosis	Number of child contacts of TB cases and their basic characteristics	Routinely record details of all cases and their household contacts
	Proportion of children who attend for screening in community and at the clinic	Cohort study of consecutive household contacts (n = 500)a
	Proportion of children diagnosed with or without TB that are misclassified	Review of all case notes over the previous 6 months
	Proportion of children who require clinical follow up to clarify diagnosis	Review of all case notes over the previous 6 months
	Proportion of those who require follow-up that complete it to a diagnostic decision	Review of all case notes over the previous 6 months
Medication	Availability and consistency of medicine supply	Annual survey of supply outlets
	Current quality	Annual analysis of drug quality in random samples
	Current cost	Annual review of cost
Adherence/acceptability	Proportion of adherent children	Cohort of consecutively treated children (n = 500)b
	Proportion of temporary default children	Cohort of consecutively treated children (n = 500)b
	Proportion of permanent default children	Cohort of consecutively treated children (n = 1,000)b
	Patient/parent acceptability	Qualitative survey of caregivers (n = 30-50)
	Clinician and staff acceptability	Qualitative survey of staff from various disciplines (n = 30–50)
Treatment outcome	Number of children (<5 years) on preventive treatment who develop TB	Cohort of consecutively treated children, 1 year follow-up (n = 2,000)c
	Proportion with side effects of preventive treatment	Cohort of consecutively treated children (n = 200)d
	Proportion stopping treatment because of side effects of medication	Cohort of consecutively treated children (n = 200)d
Cost	Cost to clinic	Survey of key staff (n = 10)
	Direct and indirect costs to child and caregiver	Survey of primary caregivers (n = 50)

^aIndex cases interviewed at diagnosis to identify case, contact, and household factors associated with non-attendance. A study of 500 contacts is advised, assuming non-attendance of at least 20%.

^bCohort study of 500 enables evaluation of risk factors for non-adherence (taking <80% of doses) and temporary defaulting (not taking medicine for at least one week), assuming at least 20% non-adherence; enlarged to 1,000 assuming permanent default rate is at least 10%.

^c n = 2,000 is estimated to identify “secondary cases” on the basis of 60%–90% efficacy of preventive therapy, an assumption of >80% adherence and a natural progression off treatment of up to 20% over one year [2].

^dCohort of 200 is based on an expected incidence of symptomatic hepatotoxicity due to IPT of <10% over a treatment course in children [25].