Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?

Abstract

Introduction: Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM). Aim: To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to TB treatment under the Revised National Tuberculosis Control Programme (RNTCP). Materials and Methods: A retrospective cohort study was conducted that included medical record reviews of SAM children registered for TB screening and RNTCP care during July-December 2012. Results: Among 440 SAM children screened, 39 (8.8%) were diagnosed with TB. Among these, 34 (87%) initiated TB treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilograms-the current weight requirement for receiving drugs under RNTCP. Conclusion: ICF approaches are feasible at NRCs; however, screening for TB entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with TB were treated by the RNTCP. More effort is needed to link this vulnerable population to TB services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilograms.

The Impact of Funding on Childhood TB Case Detection in Pakistan

“…Studies from Pakistan, India, Nepal and Nigeria have shown that intensified case finding can result in large increases in childhood TB case notification [9,[13][14][15]. Our study indicates that injection of new resources through focused active TB case finding and contact tracing efforts can substantially raise the baseline TB case notification among children.…”

Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial

“…They found that out of the 440 children with severe acute malnutrition screened, 39 (8.8%) were diagnosed with TB. Among these, 87% initiated TB treatment [17]. A study in Ethiopia examined intensive screening of children under-5 years old in MNCH clinics and the results demonstrated the feasibility of this approach, though its impact could not be assessed due to the absence of a comparison group [18].…”

Integration of childhood TB into guidelines for the management of acute malnutrition in high burden countries

“…8 Data on TB prevalence among acutely malnourished children vary widely: 2-24% of acutely malnourished children in high TB burden settings have been diagnosed with TB. [9][10][11][12][13] The wide range observed between studies can be partly attributed to the use of varying screening strategies and access to TB diagnostics, as well as varying clinical capacity for childhood TB diagnosis and treatment among hospitalized children. Even at referral hospitals, access to diagnostic tests may be limited, 14 highlighting the need for improved access to services across all levels of the health care system, including appropriate referral pathways.…”

“…This can be challenging, particularly in resource-limited settings. 12,13 In India, evaluating for TB among children treated for SAM at nutrition rehabilitation centers resulted in a TB diagnosis for 2-9% of children, and highlighted several challenges, such as lack of qualified health care providers, limited availability of CXR and TST, and difficulties with sputum collection. 12,13 These hurdles could be overcome by increasing the capacity of health care workers to diagnose TB clinically in the absence of diagnostic tests and/or the improvement of referral systems.…”

“…12,13 In India, evaluating for TB among children treated for SAM at nutrition rehabilitation centers resulted in a TB diagnosis for 2-9% of children, and highlighted several challenges, such as lack of qualified health care providers, limited availability of CXR and TST, and difficulties with sputum collection. 12,13 These hurdles could be overcome by increasing the capacity of health care workers to diagnose TB clinically in the absence of diagnostic tests and/or the improvement of referral systems. In Malawi, among 300 children hospitalized for SAM and thoroughly investigated for TB using standard research case definitions, 27 over 25% had signs of TB exposure, <1% were microbiologically confirmed, and 7% had a probable and 66% a possible diagnosis of TB.…”