Abstract
BackgroundChildhood tuberculosis (TB) patients under India's Revised National TB Control Programme (RNTCP) are managed using diagnostic algorithms and directly observed treatment with intermittent thrice-weekly short-course treatment regimens for 6–8 months. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram) that are lower than current World Health Organization (WHO) guidelines for some patients.ObjectivesThe main aim of our study was to describe the baseline characteristics and treatment outcomes reported under RNTCP for registered childhood (age <15 years) TB patients in Delhi. Additionally, we compared the reported programmatic treatment completion rates between children treated as per WHO recommended anti-TB drug doses with those children treated with anti-TB drug doses below that recommended in WHO guidelines.MethodsFor this cross-sectional retrospective study, we reviewed programme records of all 1089 TB patients aged <15 years registered for TB treatment from January to June, 2008 in 6 randomly selected districts of Delhi. WHO disease classification and treatment outcome definitions are used by RNTCP, and these were extracted as reported in programme records.Results and ConclusionsAmong 1074 patients with records available, 651 (61%) were females, 122 (11%) were <5 years of age, 1000 (93%) were new cases, and 680 (63%) had extra-pulmonary TB (EP-TB)—most commonly peripheral lymph node disease [310 (46%)]. Among 394 pulmonary TB (PTB) cases, 165 (42%) were sputum smear-positive. The overall reported treatment completion rate was 95%. Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO. Further studies are needed to assess the reasons for the low proportion of under-5 years of age TB case notifications, address challenges in reaching all childhood TB patients by RNTCP, the accuracy of diagnosis, and the clinical validity of reported programme defined treatment completion.
Highlights
Childhood tuberculosis (TB) has traditionally had a lower priority than adult TB within National TB Programmes (NTPs), because it is largely non-infectious, cases have been thought to be few, and the assumption that effective control of adult TB could prevent childhood TB
World Health Organization (WHO) disease classification and treatment outcome definitions are used by Revised National TB Control Programme (RNTCP), and these were extracted as reported in programme records
Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO
Summary
Childhood tuberculosis (TB) has traditionally had a lower priority than adult TB within National TB Programmes (NTPs), because it is largely non-infectious, cases have been thought to be few, and the assumption that effective control of adult TB could prevent childhood TB. Concerns have been expressed over the adequacy of drug dosages [4], [9], [10], [11], [12] In addition to these concerns, NTPs face operational challenges in ensuring that all diagnosed childhood TB patients are notified and treated under the programme, addressing issues related to drug logistic management, and achieving adherence to therapy for optimal treatment outcomes [13]. Amidst all these challenges, one of the first things a programme can do is to obtain and evaluate data already existing within the programme setting to identify priority areas for programmatic interventions. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram) that are lower than current World Health Organization (WHO) guidelines for some patients
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