Improving childhood tuberculosis detection and treatment through facility-based screening in rural Pakistan.

SETTING: Many children with tuberculosis (TB) remain undiagnosed due to the absence of services, lack of child-friendly diagnostics and underappreciation of TB as a common cause of childhood illness. OBJECTIVE: To show the impact of systematic verbal screening and contact tracing with appropriate management services on TB case finding in pediatric populations. DESIGN: Between October 2014 and March 2016, children were verbally screened at the pediatric out-patient departments of four public hospitals in Jamshoro District, Pakistan. Children with symptoms or risk of TB were referred for clinical evaluation and free chest X-ray and bacteriological tests. Children with TB were started on treatment and their care givers asked to bring household members to the hospital for screening. RESULTS: Over 105 000 children were verbally screened and 5880 presumptive childhood TB patients were identified; 1417 children (prevalence 1.3%) were diagnosed with TB; 43% were female. The median age was 5 years; 82% had pulmonary TB. An additional 390 children with TB were diagnosed through contact tracing. These activities resulted in a three-fold increase in pediatric TB case notifications. CONCLUSION: Systematic verbal screening with clinical evaluation and free diagnostics can identify children with TB who may otherwise be missed in rural health settings.

Unmasking childhood tuberculosis in Pakistan: efforts to improve detection and management.

Childhood tuberculosis (TB) is getting increasing global attention, as tuberculous infection and TB disease in children indicate ongoing transmission in the community. In this note from the field, we highlight issues in child TB detection, management and prevention; child TB underdiagnosis, under-reporting and lack of integration with the National TB Programme are the main challenges faced in rural settings in Pakistan. We provide examples of solutions to overcome some of these challenges and enable early TB diagnosis, effective management and disease prevention in children.