RESUMO
Background Multidrug-resistant tuberculosis (MDR-TB) presents a significant global health challenge, particularly in developing countries. This study focuses on the burden and pattern of pediatric and adolescent MDR-TB in a tertiary care hospital setting. Aims/objectives The main objective is to evaluate MDR-TB's prevalence and resistance patterns among pediatric and adolescent patients, highlighting critical demographic factors and resistance trends. Materials and methods The study utilized a prospective analytical design in two tertiary care facilities, focusing on children aged four months to 18 years diagnosed with extra-pulmonary tuberculosis. Data on demographic profiles, clinical outcomes, and drug resistance patterns were collected and analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 27.0, Armonk, NY). Results Out of 99 enrolled participants, 63 (63.64%) met the inclusion criteria. The mean age was 70.22±48.90 months. A significant proportion, 60 (95.2%) of the cases, originated from Punjab. Notably, 10 (15.9%) of the cultures demonstrated MDR, with specific resistance observed to isoniazid (INH) in 10 (15.9%) cases, rifampicin (RIF) in 11 (17.5%) cases, and pyrazinamide (PZA) in seven (11.1%) cases. The study also recorded a high prevalence of tuberculous meningitis, affecting 52 (82.5%) participants, and malnutrition, affecting 49 (77.8%). Conclusions MDR-TB in 10 (15.9%) of the study children and adolescents presenting in Pakistan's specialized health centres is a notable burden. This points to a need for better diagnostic methods and treatment plans for pediatric patients. Implementing advanced diagnostics and personalized therapies is crucial for managing MDR-TB in susceptible demographics. Our findings emphasize the importance of updating treatment protocols to tackle the impacts of MDR-TB and its evolving resistance.
RESUMO
PURPOSE: Prompt diagnosis of TB among adolescents may reduce transmission and improve individual outcomes. However, TB diagnosis in adolescents is challenging. This study sought to understand challenges to adolescent TB diagnosis. METHODS: We conducted qualitative focus group discussions (FGDs) to explore adolescents' and health workers' perspectives on challenges to TB diagnosis among adolescents seeking care at four secondary health care facilities in Uganda. Eight FGDs were conducted: four with 32 adolescents consulting for medical care and four with 34 health workers involved in TB care. RESULTS: Adolescents were aware of TB and associated risk factors and believed behaviours like smoking and alcohol use are risk factors for TB. They reported school schedules limit them from seeking TB care and have to miss school or wait for holidays to seek TB diagnosis. They noted school nurses do not take much interest in diagnosing TB and do not refer them to hospitals for further evaluation when they present with TB symptoms. Furthermore, adolescents reported cross-cutting issues like loss of trust in public health systems, encountering unfriendly, judgmental and uncooperative health workers. Health workers mentioned the school environment exposes adolescents to TB as the dormitories they sleep in are overcrowded. They indicated that it was difficult to make a diagnosis of TB in adolescents as the adolescents do not disclose health information. They reported fellow health workers perceive adolescents as being at low risk of TB as they believe most often adolescents are HIV negative and thus have reduced risk of TB. CONCLUSION: Adolescents present unique challenges that need to be addressed if TB diagnosis is to improve. These challenges could be handled by interventions that lead to minimal disruptions on school schedules, provision of adolescent-friendly services and intervention to build capacity of health care workers in the provision of adolescent-friendly services.