Exploring Gender Disparity in Nutritional Status and Dietary Intake of Adolescents in Uttarkashi

Fatima³

et al. 2021

BMC Public Health

Background In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support. However, diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods We used a cross-sectional study, which was based on a national survey measuring under-reporting of children with TB in 12 selected districts in Pakistan from April–June, 2016. We explored the practices of the private health care providers, including the health care workers i.e. general practitioners, pediatricians, pulmonologists and chest specialists, who were involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB. Results Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG (Bacillus Calmette–Guérin) scar was more common in female children. Private providers relied on chest X-ray in 46.1%, while tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP). Conclusion This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but the cases identified in these investigations were often not notified to the NTP. This problem could be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.

Section: Discussionmentioning

confidence: 99%

How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study

Fatima³

et al. 2021

BMC Public Health

“…This can be partly a biological difference and effect of culture and nutrition [32], but could also be partly because of confounding by age, as the girls diagnosed had a higher proportion of adolescents (28%) than the boys (16.9%). A study in India showed that the dietary intake of energy, iron, calcium and protein was signi cantly higher in boys than girls [33]. The slightly higher absence of BCG scar in girls could be explained by less care for girls in Pakistan, where a boy is usually more valued than girl.…”

Section: Discussionmentioning

confidence: 99%

How do private practitioners in Pakistan manage children suspected having tuberculosis?

Fatima³

et al. 2020

Preprint

Background:Private providers provide a large portion of health care in Pakistan, including tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision and support. Diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods:This cross-sectional study was based on a national survey that measured under-reporting of children with TB in 12 selected districts in Pakistan from Apr-Jun, 2016. We explored the practices of private health care providers, like general practitioners, pediatricians, pulmonologists and chest specialists, involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB.Results:Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG scar was more common in female children. Private providers relied on chest X-ray in 46.1%, but tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP).Conclusion:This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but cases identified in investigations were often not notified to the NTP. This problem needs to be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.

“…This can be partly a biological difference and effect of culture and nutrition [29]. A study in India showed that the dietary intake of energy, iron, calcium and protein was signi cantly higher in boys than girls [30]. The slightly higher absence of BCG scar in girls could be explained by less care for girls in Pakistan, where a boy is usually more valued than a girl [31].…”

Section: Discussionmentioning

confidence: 99%

How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study

Fatima³

et al. 2020

Preprint

Background:In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support. However, diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods:We used a cross-sectional study, which was based on a national survey measuring under-reporting of children with TB in 12 selected districts in Pakistan from April-June, 2016. We explored the practices of the private health care providers, including the health care workers i.e. general practitioners, pediatricians, pulmonologists and chest specialists, who were involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB.Results:Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG scar was more common in female children. Private providers relied on chest X-ray in 46.1%, while tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP).Conclusion:This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but the cases identified in these investigations were often not notified to the NTP. This problem could be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.