The Impact of Funding on Childhood TB Case Detection in Pakistan

Malik, Amyn A.; Hussain, Hamidah; Creswell, Jacob; Siddiqui, Sara; Ahmed, Junaid; Madhani, Falak; Habib, Ali; Khan, Aamir; Amanullah, Farhana

doi:10.3390/tropicalmed4040146

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…Childhood TB cases detection performance remained below-set targets as inputs and processes that fed into the program were insu cient. In contrast to our ndings, Malik et al (2019) in Pakistan reported that adequate funding and resources played an important role in improving the performance of TB case detection (13). Our study revealed that ten tuberculin skin test ampoules expired in 2020 without being requested from the pharmacy.…”

Section: Discussioncontrasting

confidence: 98%

An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

Chimsimbe

Mucheto

Juru

et al. 2021

Preprint

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Background Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the national 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. Methods We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7TM to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. Results The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair childhood TB notification knowledge. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400mg was out of stock and adult 800mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. Conclusion The childhood TB program failed to meet its targets due to inadequate inputs and suboptimal HW childhood TB knowledge. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

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Section: Discussioncontrasting

confidence: 98%

An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

Chimsimbe

Mucheto

Juru

et al. 2021

Preprint

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“…In Indonesia, a community-based organization (CBO) increased TB notification numbers significantly through ACF initiatives aimed at remote island populations [ 37 ]. Similar increases have been attributed to ACF initiatives in Pakistan [ 38 , 39 ] and Cambodia [ 40 ].…”

Section: Active Case Findingsupporting

confidence: 68%

The TB REACH Initiative: Supporting TB Elimination Efforts in the Asia-Pacific

Creswell¹,

Khan²,

Bakker

et al. 2020

TropicalMed

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After many years of TB ‘control’ and incremental progress, the TB community is talking about ending the disease, yet this will only be possible with a shift in the way we approach the TB response. While the Asia-Pacific region has the highest TB burden worldwide, it also has the opportunity to lead the quest to end TB by embracing the four areas laid out in this series: using data to target hotspots, initiating active case finding, provisioning preventive TB treatment, and employing a biosocial approach. The Stop TB Partnership’s TB REACH initiative provides a platform to support partners in the development, evaluation and scale-up of new and innovative technologies and approaches to advance TB programs. We present several approaches TB REACH is taking to support its partners in the Asia-Pacific and globally to advance our collective response to end TB.

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“…Those reports may have identified these factors as predictors of poor outcomes because the majority were set within programs relying only on passive TB finding, which is characterized by delayed diagnoses due to nonspecific symptoms and difficulty diagnosing young children who cannot produce a sputum specimen. The present study was an intensified TB patient-finding intervention [ 23 , 24 ], which was designed to identify these children earlier in their clinical disease course and initiate treatment more rapidly. Additionally, although bacteriological positivity [ 9 , 19 , 21 ] and HIV status [ 10 , 11 , 13 , 16 - 19 ] were identified in previous studies to increase the risk of a child experiencing an unsuccessful treatment outcome, we did not adjust for these variables in this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Between October 2014 and March 2016, an intensified TB patient-finding intervention was implemented in collaboration with the Provincial TB Control Program with the aim of increasing childhood TB detection and notification through systematic verbal screening of all people seeking health care at four participating health facilities in Jamshoro district, Sindh, Pakistan. More details about this intensified TB patient-finding intervention have been reported previously [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Predictors of unsuccessful tuberculosis treatment outcomes in children from a prospective cohort study in Pakistan

et al. 2021

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Background Every year, about 239 000 children die from tuberculosis (TB), despite availability of highly effective regimens. Few studies have evaluated predictors for poor treatment outcomes in children treated for TB. Methods We assessed predictors of unsuccessful TB treatment outcomes in a prospective cohort of children diagnosed by an intensified TB patient-finding intervention at four facilities in Pakistan between 2014 and 2016. A case of TB disease was determined through either bacteriologic confirmation of disease or a clinical diagnosis. To estimate characteristics predictive of experiencing an unsuccessful treatment outcome, we used a multi-level model with a modified Poisson approach, accounting for clustering at the facility level. We report estimated relative risks (RR) and 95% confidence intervals (CI). Results During the study period, 1404 children less than 15 years old were initiated on treatment for drug-susceptible TB. In total, 709 (50.5%) were 0-4, 406 (28.9%) were 5-9 years, and 289 (20.6%) were 10-14 years old; 614 (43.7%) were female; and of the 1377 children assessed for malnourishment, 1161 (84.3%) were malnourished. A total of 1322 (94.2%) children experienced a successful treatment outcome, 14 (1.0%) children transferred out to a different facility, and 68 (4.8%) children experienced an unsuccessful treatment outcome: 14 (1.0%) died, 20 (1.4%) failed treatment, and 34 (2.4%) were lost to follow-up. After adjustment for age group, sex, and malnutrition status, we identified increased risk of unsuccessful treatment outcome in children presenting with fever (RR = 2.56, 95% CI = 1.02-6.44; P = 0.05) or an abdominal examination suggestive of TB disease (RR = 2.34, 95% CI = 1.20-4.58; P = 0.01), and a decreased risk in children who initiated treatment at a rural facility (RR = 0.05, 95% CI = 0.00-0.74; P = 0.03). Conclusions More than 94% of children experienced successful treatment outcomes. We identified individual-, facility-, and clinical-factors predictive of experiencing unsuccessful treatment outcomes. Children with fevers and abdominal findings suggestive of TB disease should be tested for TB and followed closely throughout treatment to ensure necessary support for successful completion of treatment.

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The Impact of Funding on Childhood TB Case Detection in Pakistan

Cited by 14 publications

References 16 publications

An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

The TB REACH Initiative: Supporting TB Elimination Efforts in the Asia-Pacific

Predictors of unsuccessful tuberculosis treatment outcomes in children from a prospective cohort study in Pakistan

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