Measuring and addressing the childhood tuberculosis reporting gaps in Pakistan: The first ever national inventory study among children


Autoři: Razia Fatima aff001;  Aashifa Yaqoob aff001;  Ejaz Qadeer aff003;  Sven Gudmund Hinderaker aff002;  Aamer Ikram aff001;  Charalambos Sismanidis aff005
Působiště autorů: Common Management Unit (HIV/AIDS, TB & Malaria), Islamabad, Pakistan aff001;  University of Bergen, Bergen, Norway aff002;  Pakistan Institute of Medical Sciences, Islamabad, Pakistan aff003;  National Institute of Health, Islamabad, Pakistan aff004;  Global TB Programme, World Health Organization, Geneva, Switzerland aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227186

Souhrn

Introduction

Tuberculosis in children may be difficult to diagnose and is often not reported to routine surveillance systems. Understanding and addressing the tuberculosis (TB) case detection and reporting gaps strengthens national routine TB surveillance systems.

Objective

The present study aimed to measure the percentage of childhood TB cases that are diagnosed but not reported to the national surveillance system in Pakistan.

Design

The study design was cross sectional. The study was nationwide in 12 selected districts across Pakistan, each representing a cluster. Health facilities that diagnose and treat childhood TB from all sectors were mapped and invited to participate. Lists of child TB cases were created for the study period (April-June 2016) from all study facilities and compared against the list of child TB cases notified to the national TB surveillance system for the same districts and the same period.

Results

All public and private health facilities were mapped across 12 sampled districts in Pakistan and those providing health services to child TB cases were included in the study. From all private health facilities, 7,125 children were found with presumptive TB during the study period. Of them, 5,258 were diagnosed with tuberculosis: 11% were bacteriologically-confirmed and 89% clinically-diagnosed; only 4% were notified to National TB Control Program. An additional 1,267 children with TB were also registered in the National TB Control Program. Underreporting was measured to be 78%.

Conclusion

This is the first nationwide childhood TB inventory study globally and confirmed that childhood TB underreporting is very high in Pakistan. TB surveillance in the country must be strengthened to address this, with particular attention to guiding and supporting general practitioners and pediatricians to notify their TB cases.

Klíčová slova:

Health care providers – Child health – Children – Pakistan – Pediatrics – Sputum – Tuberculosis – Tuberculosis diagnosis and management


Zdroje

1. World Health Organization. Roadmap towards ending TB in children and adolescents. WHO: Geneva Switzerland; 2018.

2. WHO. Global tuberculosis report 2018. Geneva: World Health Organization; 2018.

3. World Health Organization. WHO | Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva, Switzerland:WHO: World Health Organization; 2014.

4. World Health Organization. Estimating TB incidence among children. WHO: Geneva, Switzerland; 2018.

5. World Health Organization. Roadmap for childhood tuberculosis towards zero deaths. Geneva, Switzerland:WHO; 2013.

6. World Health Organization. Assessing tuberculosis Under-Reporting Through Inventory Studies. Geneva, Switzerland:WHO; 2012.

7. National TB Control Program. Revised: DOCTOR’S DESK GUIDE MANAGEMENT OF CHILDHOOD TUBERCULOSIS. Islamabad, Pakistan; 2017.

8. National TB Control Program. National guidelines for diagnosis and management in Children. Islamabad, Pakistan; 2006.

9. Fatima R, Haq MU, Yaqoob A, Mahmood N, Ahmad KL, Osberg M, et al. Delivering Patient-Centered Care in a Fragile State: Using Patient-Pathway Analysis to Understand Tuberculosis-Related Care Seeking in Pakistan. J Infect Dis. 2017;216: S733–S739. doi: 10.1093/infdis/jix380 29117348

10. World Health Organization. Global Tuberculosis Report 2017. Geneva, Switzerland:WHO; 2017.

11. Fatima R, Harris RJ, Enarson DA, Hinderaker SG, Qadeer E, Ali K, et al. Estimating tuberculosis burden and case detection in Pakistan. Int J Tuberc Lung Dis. 2014;18: 55–60. doi: 10.5588/ijtld.13.0198 24365553

12. National TB Control Program. National guidelines for diagnosis and management of tuberculosis in children 2006–07. Islamabad, Pakistan; 2007.

13. Hong SJ, Park YS, An H, Kang SM, Cho EH, Shin SS. Factors leading to under-reporting of tuberculosis in the private sector in Korea. Int J Tuberc Lung Dis. 2012;16: 1221–1227. doi: 10.5588/ijtld.11.0782 22794136

14. Lestari T, Probandari A, Hurtig AK, Utarini A. High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: A cross sectional study. BMC Public Health. 2011;11.

15. Coghlan R, Gardiner E, Amanullah F, Ihekweazu C. Understanding Market Size and Reporting Gaps for Paediatric TB in Indonesia, Nigeria and Pakistan: Supporting Improved Treatment of Childhood TB in the Advent of New Medicines. PLoS One. 2015;10: 1–12.

16. Oshi DC, Chukwu JN, Nwafor CC, Meka AO, Madichie NO, Ogbudebe CL, et al. Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria. Int J Mycobacteriology. 2015;5: 44–50.

17. Dodd PJ, Gardiner E, Coghlan R, Seddon JA. Burden of childhood tuberculosis in 22 high-burden countries: A mathematical modelling study. Lancet Glob Heal. 2014;2.

18. Parsons Linda M., Somoskovi Akos, Gutierrez Cristina, Lee Evan P CN, Abimiku Alash’le, Spector Steven, Roscigno Giorgio and N J. Laboratory diagnosis of tuberculosis in resource-poor Countries: Challenges and opportunities. Clin Microbiol Rev. 2011;24: 314–350. doi: 10.1128/CMR.00059-10 21482728

19. Treatment Action Group. Tuberculosis Diagnostic Tools. New York; 2017.

20. Islam Z, Sanin KI, Ahmed T. Improving case detection of tuberculosis among children in Bangladesh: lessons learned through an implementation research. BMC Public Health. 2017;17: 1–9.

21. Talukder K, Salim MAH, Jerin I, Sharmin F, Talukder MQK, Marais BJ, et al. Intervention to increase detection of childhood tuberculosis in Bangladesh. Int J Tuberc Lung Dis. 2012;16: 70–75. doi: 10.5588/ijtld.11.0060 22236849

22. Kruk A, Gie RP, Schaaf HS, Marais BJ. Symptom-Based Screening of Child Tuberculosis Contacts: Improved Feasibility in Resource-Limited Settings. Pediatrics. 2008;121: e1646–e1652. doi: 10.1542/peds.2007-3138 18519467

23. Mandalakas AM, Hesseling AC, Gie RP, Schaaf HS, Marais BJ, Sinanovic E. Modelling the cost-effectiveness of strategies to prevent tuberculosis in child contacts in a high-burden setting. Thorax. 2013;68: 247–255. doi: 10.1136/thoraxjnl-2011-200933 22717944

24. Detjen A, Grzemska M, Sm G, Sismanidis C. Improving the estimates of childhood TB disease burden and assessing childhood TB activities at country level.

25. Onozaki I, Law I, Sismanidis C, Zignol M, Glaziou P, Floyd K. National tuberculosis prevalence surveys in Asia, 1990–2012: an overview of results and lessons learned. Trop Med Int Health. 2015.

26. Donald PR. Childhood tuberculosis: The hidden epidemic. International Journal of Tuberculosis and Lung Disease. 2004. pp. 627–629. 15137546

27. Marais BJ, Graham SM, Maeurer M, Zumla A. Progress and challenges in childhood tuberculosis. Lancet Infect Dis. 2013;13: 287–289. doi: 10.1016/S1473-3099(13)70031-8 23531386

28. Marais BJ, Graham SM. Childhood tuberculosis: A roadmap towards zero deaths. J Paediatr Child Health. 2016;52: 258–261. doi: 10.1111/jpc.12647 24923706


Článek vyšel v časopise

PLOS One


2019 Číslo 12