Holistic care of complicated tuberculosis in healthcare settings with limited resources

Abstract

In recent years, most of the focus on improving the quality of paediatric care in low-income countries has been on improving primary care using the Integrated Management of Childhood Illness, and improving triage and emergency treatment in hospitals aimed at reducing deaths in the first 24 hours. There has been little attention paid to improving the quality of care for children with chronic or complex diseases. Children with complicated forms of tuberculosis (TB), including central nervous system and chronic pulmonary TB, provide examples of acute and chronic multisystem paediatric illnesses that commonly present to district-level and second-level referral hospitals in low-income countries. The care of these children requires a holistic clinical and continuous quality improvement approach. This includes timely decisions on the commencement of treatment often when diagnoses are not certain, identification and management of acute respiratory, neurological and nutritional complications, identification and treatment of comorbidities, supportive care, systematic monitoring of treatment and progress, rehabilitation, psychological support, ensuring adherence, and safe transition to community care. New diagnostics and imaging can assist this, but meticulous attention to clinical detail at the bedside and having a clear plan for all aspects of care that is communicated well to staff and families are essential for good outcomes. The care is multidimensional: biomedical, rehabilitative, social and economic, and multidisciplinary: medical, nursing and allied health. In the era of the Sustainable Development Goals, approaches to these dimensions of healthcare are needed within the reach of the poorest people who access district hospitals in low-income countries.

Experience and Perception of Healthcare Workers on the Challenges of Follow-Up and Treatment of Tuberculosis Patients in Southern Ethiopia: An Exploratory-Descriptive Qualitative Study

“…This finding is reported similarly in other studies conducted in Accra Metropolis, Ghana, and Australia. 33 , 34 …”

Oral Anti-Tuberculosis Drugs: An Urgent Medication Reconciliation at Hospitals in Indonesia

“…For most patients, the journey can: "involve a family member having TB, multiple presentations to health professionals, previous courses of antibiotic treatments or truncated courses of TB treatment, non-adherence or defaulting from treatment, premature discharge from a health facility and relapse with a more severe form of TB." 37 Understanding the timeline and journey can help health professionals assess risk at the time of discharge planning, and understand families' experiences of using health services. Risk assessment is required at specific milestones (every 6 months) in the treatment.…”

“…“involve a family member having TB, multiple presentations to health professionals, previous courses of antibiotic treatments or truncated courses of TB treatment, non-adherence or defaulting from treatment, premature discharge from a health facility and relapse with a more severe form of TB.” 37 …”

Plant‐based Food Products for Antimycobacterial Therapy

“…The traditional medicine, which is often based on a holistic approach, could provide a new and interesting perspective on TB treatment. This approach include not only the eradication of bacteria, but also boosting natural immunity, managing disease symptoms, as well as proper nutrition and diet supplementation [19]. Those goals can be achieved using plant‐based food products.…”