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

Rajeev R Pathak,Mohit P Gandhi,Shamim Mannan,Bal Krishna Mishra,Sreenivas A Nair,Patrick K Moonan,Smita Ghosh,Ajay M V Kumar

doi:10.4236/jtr.2016.41006

Abstract

Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM). 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). 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. 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. 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.

Highlights

Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM)
We reported case counts and proportions of select demographic characteristics amongst children that were screened and diagnosed with TB according to the Indian Academy of Pediatrics (IAP) diagnostic algorithm and the proportion that were linked to Revised National Tuberculosis Control Programme (RNTCP) for treatment and care [15] [16]
During July-December, 2012, a total of 440 SAM children were admitted to the district-level NRCs

Summary

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). Risk factors for TB in children include 1) age less than 5 years; 2) close/household contacts with a case of pulmonary TB (especially smear-positive or culture-positive pulmonary TB); 3) HIV infection, and 4) severe malnutrition [1]-[3]. One of the 10 steps in the WHO’s “Roadmap for childhood TB: Steps towards zero deaths” specifies not missing critical opportunities for intervention [2] Another step outlined in the same document recommends developing community-centered strategies for children [2]

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Conclusion