Abstract
Objective of the StudyWe sought to understand gaps in reporting childhood TB cases among public and private sector health facilities (dubbed “non-NTP” facilities) outside the network of national TB control programmes, and the resulting impact of under-reporting on estimates of paediatric disease burden and market demand for new medicines.MethodologyExploratory assessments were carried out in Indonesia, Nigeria and Pakistan, reaching a range of facility types in two selected areas of each country. Record reviews and interviews of healthcare providers were carried out to assess numbers of unreported paediatric TB cases, diagnostic pathways followed and treatment regimens prescribed.Main FindingsA total of 985 unreported diagnosed paediatric TB cases were identified over a three month period in 2013 in Indonesia from 64 facilities, 463 in Pakistan from 35 facilities and 24 in Nigeria from 20 facilities. These represent an absolute additional annualised yield to 2013 notifications reported to WHO of 15% for Indonesia, 2% for Nigeria and 7% for Pakistan. Only 12% of all facilities provided age and sex-disaggregated data. Findings highlight the challenges of confirming childhood TB. Diagnosis patterns in Nigeria highlight a very low suspicion for childhood TB. Providers note the need for paediatric medicines aligned to WHO recommendations.Conclusion: How Market Data Can Support Better Public Health InterventionsThis study emphasises the impact of incomplete reporting on the estimation of disease burden and potential market size of paediatric TB medicines. Further studies on “hubs” (facilities treating large numbers of childhood TB cases) will improve our understanding of the epidemic, support introduction efforts for new treatments and better measure markets for new paediatric medicines.
Highlights
Childhood TB has long been a neglected health problem, with little national or international attention, especially for those under five years [1,2,3,4,5,6]
The study combined a review of patient records and interviews of non-National TB Programmes (NTP) sector healthcare providers in Indonesia, Nigeria and Pakistan to understand gaps in the reporting of children seen in non-NTP facilities, to assess diagnostic and treatment pathways for paediatric TB cases, and to generate further information around the paediatric TB medicines market
Based on the records available and provider interviews, a total of 985 diagnosed but unreported paediatric TB cases were identified for a three-month period in Indonesia in 53 facilities, 463 cases in Pakistan in 35 facilities and 24 cases in Nigeria in 20 facilities
Summary
Childhood TB has long been a neglected health problem, with little national or international attention, especially for those under five years [1,2,3,4,5,6]. Despite increased awareness and interest in paediatric TB data, well-described difficulties remain in the estimation of burden of childhood TB [9,10, 13,14] This is mainly due to the lack of age-specific national TB surveillance data [9,10,11], difficulties with diagnosis [15,16,17,18] and gaps in reporting of childhood TB cases from both public and private sector facilities outside the network of the National TB Programmes ( referred to as non-NTP facilities) [10, 19,20,21,22]. The non-NTP sector here includes both not-for-profit and for-profit healthcare facilities and medicine-dispensing outlets (e.g. pharmacies and drug shops) involved in the diagnosis or treatment of paediatric TB cases This includes public sector facilities not under the management of the National TB Programmes
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