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Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3
Nauman Safdar1, Sven Gudmund Hinderaker, Noor Ahmed Baloch
1Association for Social Development, Islamabad, Pakistan. Nauman.Safdar@cih.uib.no.
Insights
National TB Control Programme (NTP) policy guidelines improved childhood tuberculosis case management practices in Pakistan. However, inadequate record-keeping and unknown treatment outcomes highlight the need for standardized tools and monitoring.
Area of Science:
- Pediatric Infectious Diseases
- Public Health Policy
- Tuberculosis Management
Background:
- Adherence to National TB Control Programme (NTP) policies is crucial for successful tuberculosis (TB) management.
- Childhood TB services face challenges in diagnosis and adapting to new policies.
- Pakistan's NTP developed and piloted childhood TB management guidelines in 2006-2007.
Purpose of the Study:
- To compare pediatricians' documented case management practices before and after the introduction of NTP policy guidelines.
- To assess the impact of these guidelines on childhood TB case management outcomes.
Main Methods:
- A historical cohort study audited case management practices in children under 15 years.
- Data collected from nine public hospitals in Punjab over two years pre-intervention (2004-05) and two years post-intervention (2006-07).
- Compared the use of diagnostic tools and treatment outcomes before and after guideline implementation.
Main Results:
- Significant increase in the use of tuberculin skin test and chest x-ray post-intervention.
- The proportion of correctly prescribed anti-TB drugs remained consistent.
- Unknown treatment outcomes increased substantially post-intervention, particularly in cases without a documented treatment supporter.
Conclusions:
- Pediatricians partially adopted national policy guidelines, increasing diagnostic tool usage.
- Record-keeping of case management practices remains inadequate.
- Improved case finding was observed, but poor treatment outcomes necessitate standardized operational tools and monitoring systems.
Background:
The adherence to policies of National TB Control Programme (NTP) to manage a case of tuberculosis (TB) is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines.
Findings:
An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05) and two years post-intervention (2006-07) after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown), and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown). Diagnostic scores were recorded for only a minority of cases (18%). The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27%) in pre-intervention and in 483 out of 551 cases (87%) post-intervention, all among the 692 cases without documented treatment supporter.
Conclusions:
The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case management practices remained inadequate. This seems to increase case finding substantially but the treatment outcomes were poor mainly due to unknown outcomes. Development and implementation of standardized operational tools and regular monitoring system may improve the services.
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