ASD - PAKISTAN

Child TB Case Management, Pakistan

Childhood TB constitutes 3% to 25% of all cases reported world wide and 3-13% in Pakistan. However, the magnitude of childhood TB may be underestimated because of the diagnostic difficulties as most children are not smear positive TB, it is likely that there is incorrect and under diagnosis. The NTP Pakistan in collaboration with Pakistan Paediatric Association has developed the National technical guidelines for management of tuberculosis in children. The guideline, a reference booklet in conventional text, covering various components of childhood TB diagnosis and care has been distributed to paediatricians in 10 districts of Pakistan. However there are several unanswered technical and operational areas in the National guidelines that could potentially lead to errors in diagnoses and follow-up of a child with TB. The interpretation of clinical and laboratory investigations, and follow up of care are vague. There is limited research information on the ways and means to effectively implement childhood TB care delivery in programmatic conditions. Without addressing the case management issues systematically there will be inevitable variation in the quality of care by the paediatrician primarily responsible for child TB care in a district hospital. This aims to review the available national and international guidelines to draft a case management desk-guide, a training module, and a guide for structured hospital monitoring process for childhood TB case management and implement the desk-guide and training materials in 8 selected district level hospitals (with pediatric departments) in the province of Punjab.

 

The proposed research focuses on the diagnosis and case management of childhood TB in Pakistan. The project will provide an opportunity to study, develop, implement and evaluate a childhood TB case management desk-guide and training materials. The desk guide will help to make the care delivery process more structured and simpler and also address the gaps to diagnose and follow-up a child with TB. The research will be implemented in eight selected district hospitals in the province of Punjab, Pakistan. The evaluation will assess the effectiveness and feasibility of use, and will use a combination of qualitative and quantitative research methods. It will provide in-depth information on diagnosis and treatment outcomes related to children with TB. In collaboration with tuberculosis programme, the guideline will be refined and made available for implementation in other districts of the country. The study will also provide strong basis of learning for the up-coming national initiatives in Pakistan, namely the implementation of childhood TB care in the teaching hospitals of the entire country through global fund.