Delays and barriers to early treatment initiation for childhood tuberculosis in India.

BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.

Barriers to screening and isoniazid preventive therapy for child contacts of tuberculosis patients.

BACKGROUND: India's guidelines recommend tuberculosis (TB) screening of household contacts aged <6 years and isoniazid preventive therapy (IPT) for children without active disease. We evaluated the current status and barriers to screening and IPT provision among the child contacts of TB patients. METHODS: Questionnaire and health record data were collected from index cases and health care providers (HCPs) at Sassoon General Hospital, Pune, India. RESULTS: Of 80 adult TB cases, 24 (30%) reported that an HCP recommended TB screening of their child contacts; 49/178 (28%) child contacts were screened. Sixteen (33%) children had active TB, and 28 (85%) of those who screened negative were prescribed IPT. Nineteen (76%) HCPs reported recommending child contact screening. Only 8 (32%) reported ever prescribing IPT. Lack of TB screening and IPT provision for child contacts was associated with inadequate HCP counseling (aOR 19.5, P < 0.001), a non-parent index case (aOR 3.72, P = 0.008) and lack of postgraduate HCP qualification (aOR 19.12, P = 0.04). CONCLUSIONS: TB screening and IPT provision for child contacts of adults with TB were infrequent. Many screened children had active TB. Universal, timely TB screening and IPT for exposed children are urgently needed to reduce pediatric TB in India.

A comparison of treatment outcome in re-treatment versus new smear positive cases of tuberculosis under RNTCP.

A study was conducted to compare and quantify the treatment outcome in re-treatment cases as compared to the new smear positive cases of Tuberculosis under Revised National Tuberculosis Control Program in District Tuberculosis Center, Yavatmal district, Maharastra in 2003. The cure rates were 68% and 84% in the new smear positive and the re-treatment group respectively. Favorable outcomes were significantly less in the re-treatment group (66.47%) as compared to the new smear positive cases (84.28%). Unfavorable outcome of default and failure was also more among different subgroups of re-treatment category.

Development of technology for the large-scale preparation of 60Co polymer film source.

(60)Co sources ( approximately 37 kBq) in the form of a thin film are widely used in position identification of perforation in offshore oil-well explorations. This paper describes the large-scale preparation of such sources using a radioactive polymer containing (60)Co. (60)Co was extracted into chloroform containing 8-hydroxyquinoline. The chloroform layer was mixed with polymethyl methacrylate (PMMA) polymer. A large film was prepared using the polymer solution containing the complex. The polymer film was then cut into circular sources, mounted on a source holder and supplied to various users.