ABSTRACT
The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.
Subject(s)
Antitubercular Agents/therapeutic use , Case Management/organization & administration , Communicable Disease Control/organization & administration , Health Policy , National Health Programs/organization & administration , Tuberculosis/drug therapy , Case Management/legislation & jurisprudence , Checklist , Child , Communicable Disease Control/legislation & jurisprudence , Health Services Research , Humans , National Health Programs/legislation & jurisprudence , Organizational Policy , Pakistan/epidemiology , Practice Guidelines as Topic , Prognosis , Program Development , Program Evaluation , Tuberculosis/diagnosis , Tuberculosis/epidemiologyABSTRACT
SETTING: All nine public sector hospitals in three districts of Pakistan. OBJECTIVE: To estimate case notifications of children with tuberculosis (TB) and their outcomes. DESIGN: A retrospective cohort following all children aged <15 years placed on TB treatment under the National TB Control Programme (NTP) in public hospitals. The study period was 2 years before and 2 years after the implementation of new NTP policy guidelines for childhood TB. Data were collected from hospital TB registers, patient treatment cards and quarterly reports. RESULTS: With the introduction of the new NTP policy, case notification of childhood TB increased from 189 (2004-2005) to 731 for the 2 years 2006-2007. The annual notification rate of childhood TB cases increased from 1.4 (2004-2005) to 5.2 per 100 000 population (2006-2007). Of the total 920 childhood TB cases registered, 610 were pulmonary, 202 extra-pulmonary and the remaining 108 unclassified. The three-fold increase in case notification was accompanied by a lack of follow-up, resulting in an increase in unknown treatment outcomes from 21.7% to 73.3%. CONCLUSION: Managing children with TB in routine NTP practice is possible, but without adequate operational guidelines, expanding services and follow-up, it can lead to suboptimal results.
Subject(s)
Antitubercular Agents/therapeutic use , Health Policy , Practice Guidelines as Topic , Tuberculosis/drug therapy , Adolescent , Antitubercular Agents/administration & dosage , Child , Child, Preschool , Cohort Studies , Disease Notification/statistics & numerical data , Female , Follow-Up Studies , Humans , Infant , Male , National Health Programs/organization & administration , Pakistan/epidemiology , Registries , Retrospective Studies , Treatment Outcome , Tuberculosis/diagnosis , Tuberculosis/prevention & controlABSTRACT
Pakistan has shown drastic expansion of tuberculosis (TB) care during the past 10 years, increasing case notifications from 11 050 in 2000 to 248 115 in 2008. Over 1 million TB patients have been cared for since 2000, with a treatment success rate of 91% in 2007. This paper examines the strategic decisions and infrastructure improvements underlying this achievement, such as the implementation of universal DOTS coverage, expansion of the laboratory network, effective drug management systems, improved communication strategies, and inclusion of private practitioners, laboratories and hospitals in the TB control programme through the public-private mix strategy. The paper also outlines challenges faced in further expanding TB control within the private sector and parastatal health care institutions; strengthening the laboratory network for diagnosis of drug-resistant TB; and ensuring uninterrupted supply of quality anti-TB drugs, all requiring continued and coordinated technical and donor support.
Subject(s)
Tuberculosis/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Humans , Pakistan/epidemiology , Program Evaluation , Public-Private Sector Partnerships , Tuberculosis/epidemiologyABSTRACT
Pakistan has shown drastic expansion oftuberculosis [TBTcareduring the past 10 years, increasing case notifications from 11 050 in 2000 to 248115 in 2008. Over 1 million TB patients have been cared for since 2000, with a treatment success rate of 91% in 2007. This paper examines the strategic decisions and infrastructure improvements underlying this achievement, such as the implementation of universal DOTS coverage, expansion of the laboratory network, effective drug management systems, improved communication strategies, and inclusion of private practitioners, laboratories and hospitals in the TB control programme through the public-private mix strategy. The paper also outlines challenges faced in further expanding TB control within the private sector and parastatal health care institutions; strengthening the laboratory network for diagnosis of drug-resistant TB; and ensuring uninterrupted supply of quality anti-TB drugs, ail requiring continued and coordinated technical and donor support
