Background: Tuberculosis (TB) is one of the major killer diseases among infectious diseases. The success of TB control depends on the capability of the health care system to detect and accurately manage TB cases. Tuberculosis in children remained a low public health priority with limited epidemiologic studies. Struggles for TB control in children need to be enhanced as children are providing the reservoir for future cases to develop. Objectives: The study evaluated diagnostic and treatment practices related to childhood pulmonary tuberculosis in Gilgit Baltistan (GB), Pakistan. Methods: A descriptive, cross-sectional study based on retrospective record review of childhood Pulmonary Tuberculosis patients registered in the year 2020 with self-administered questionnaire. Results: Data of 557 childhood cases were collected. Most childhood cases were in age group 1 - 4 years (54%) with male predominance. More than 90% were diagnosed and treated at public sector facilities. 99% of the cases were clinically diagnosed with passive case finding. Cough was considered as a symptom of childhood Tuberculosis (TB) by 94% of physicians. Other important features included failure to thrive (13%), contact with a family history of TB (15%), Malnutrition(24%) and respiratory signs (21%). 99% physicians advised chest X-ray, Complete blood count (CBC) (95%) and Erythrocytes sedimentation rate (ESR) (72%) for diagnosis and fewer physicians (2%) used sputum smear microscopy and induced sputum (0.1%). Combining data on dosage, frequency and duration for drugs, 99% of the cases were found receiving correct regimen. The treatment outcomes of the cases were cured 4 (0.8%), treatment completed 551 (99.3%) and died 2 (0.4%) with no lost to follow up. Conclusions: The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among physicians in public and private sectors of Gilgit Baltistan. Most of the cases are managed by general practitioners with no post graduate qualification in medicine or pediatrics. The deviations from the guidelines for TB control cannot be negated in the region.
References
[1]
Walls, T. and Shingadia, D. (2004) Global Epidemiology of Paediatric Tuberculosis. Journal of Infection, 48, 13-22. https://doi.org/10.1016/S0163-4453(03)00121-X
[2]
Fry, S., Barnabas, S. and Cotton, M.F. (2017) Update on Trends in Childhood Tuberculosis. Current Opinion in Pediatrics, 30, 152-160. https://doi.org/10.1097/MOP.0000000000000581
[3]
Nelson, L.J. and Wells, C.D. (2004) Global Epidemiology of Childhood Tuberculosis. The International Journal of Tuberculosis and Lung Disease, 8, 636-647.
[4]
Seddon, J.A. and Shingadia, D. (2014) Epidemiology and Disease Burden of Tuberculosis in Children: A Global Perspective. Infection and Drug Resistance, 7, 153-165. https://doi.org/10.2147/IDR.S45090
[5]
World Health Organization (2022) Global Tuberculosis Report 2021, Supplementary Material.
[6]
Marks, G.B., Nguyen, N.V., Nguyen, P.T., Nguyen, T.A., Nguyen, H.B., Tran, K.H., Nguyen, S.V., Luu, K.B., Tran, D.T., et al. (2019) Community-Wide Screening for Tuberculosis in a High-Prevalence Setting. The New England Journal of Medicine, 381, 1347-1357. https://doi.org/10.1056/NEJMoa1902129
[7]
Gunasekera, K.S., Vonasek, B., Oliwa, J., Triasih, R., Lancioni, C., Graham, S.M., et al. (2022) Diagnostic Challenges in Childhood Pulmonary Tuberculosis—Optimizing the Clinical Approach. Pathogens, 11, Article No. 382. https://doi.org/10.3390/pathogens11040382
[8]
Chimsimbe, M., Mucheto, P., Juru, T.P., Chadambuka, A. and Govha, E. (2022) An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020, a Descriptive Cross-Sectional Study. BMC Health Services Research, 22, Article No. 500. https://doi.org/10.1186/s12913-022-07918-2
[9]
Sharma, S., Sarin, R., Khalid, U.K., Singla, N., Sharma, P.P. and Behera, D. (2007) The DOTS Strategy for Treatment of Paediatric Pulmonary Tuberculosis in South Delhi, India. The International Journal of Tuberculosis and Lung Disease, 11, 74-80.
[10]
Yaqoob, A., Gudmund, S., Fatima, R., Shewade, H.D., Nisar, N. and Wali, A. (2021) Diagnosis of Childhood Tuberculosis in Pakistan: Are National Guidelines Used by Private Healthcare Providers ? International Journal of Infectious Diseases, 107, 291-297. https://doi.org/10.1016/j.ijid.2021.04.055
[11]
Jain, S.K., Andronikou, S., Goussard, P., Antani, S., Gomez-Pastrana, D., Delacourt, C., et al. (2020) Personal View Advanced Imaging Tools for Childhood Tuberculosis: Potential Applications and Research Needs. The Lancet Infectious Diseases, 20, E289-E297. https://doi.org/10.1016/S1473-3099(20)30177-8
[12]
Singhal, T. (2022) The New WHO Consolidated Guidelines for Management of Tuberculosis in Children and Adolescents: An Appraisal. Indian Journal of Pediatrics,89, 743-745. https://doi.org/10.1007/s12098-022-04280-3
[13]
Yaqoob, A., Hinderaker, S.G., Fatima, R. and Najmi, H. (2021) How Do Private Practitioners in Pakistan Manage Children Suspected Having Tuberculosis ? A Cross Sectional Study. BMC Public Health, 21, Article No. 71. https://doi.org/10.1186/s12889-020-10053-4
[14]
Dodd, P.J., Gardiner, E., Coghlan, R. and Seddon, J.A. (2012) Burden of Childhood Tuberculosis in 22 High-Burden Countries: A Mathematical Modelling Study. The Lancet Global Health, 2, E453-E459. https://doi.org/10.1016/S2214-109X(14)70245-1
[15]
Dodd, P.J., Yuen, C.M., Sismanidis, C., Seddon, J.A. and Jenkins, H.E. (2017) The Global Burden of Tuberculosis Mortality in Children: A Mathematical Modelling Study. The Lancet Global Health, 5, E898-E906. https://doi.org/10.1016/S2214-109X(17)30289-9
[16]
Ali, A., Ali, G., Muhammad, G., Attaullah, S., Karim, R., Joshi, S., et al. (2021) Factors Shaping Economics of Land Use Change in Gilgit Baltistan, Pakistan. GeoJournal, 87, 3951-3966. https://doi.org/10.1007/s10708-021-10478-3
[17]
Hussain, A., Khan, S., et al. (2022) Developing Evidence Based Policy and Programmes in Mountainous Specific Agriculture in Gilgit-Baltistan and Chitral Regions of Pakistan. Pakistan Journal of Agricultural Research, 35, 181-196. https://doi.org/10.17582/journal.pjar/2022/35.1.181.196
[18]
Fatima, R., Id, A.Y., Qadeer, E. and Hinderaker, S.G. (2019) Measuring and Addressing the Childhood Tuberculosis Reporting Gaps in Pakistan: The First Ever National Inventory Study among Children. PLOS ONE, 14, e0227186. https://doi.org/10.1371/journal.pone.0227186
[19]
Burke, R.M., Nliwasa, M., Feasey, H.R.A., Chaisson, L.H., Golub, J.E., Naufal, F., et al. (2021) Articles Community-Based Active Case-Finding Interventions for Tuberculosis: A Systematic Review. The Lancet Public Health, 6, E283-E299. https://doi.org/10.1016/S2468-2667(21)00033-5
[20]
Fox, G.J., Nhung, N.V., Sy, D.N., Hoa, N.L.P., Anh, L.T.N., Anh, N.T., et al. (2018) Household-Contact Investigation for Detection of Tuberculosis in Vietnam. The New England Journal of Medicine, 378, 221-229. https://doi.org/10.1056/NEJMoa1700209
[21]
Shakoor, S. (2019) Common Alternative Diagnoses among a Pediatric Hospital-Based Cohort Evaluated for Tuberculosis in Karachi, Pakistan: The Need for Facilitated Referral in Tuberculosis Clinics.
[22]
Ahsan, M.R., Hussain, M., Sarkar, P.K., Mahfuj, A.B.M. and Al, H. (2019) Clinical Pattern of Pediatric Tuberculosis in a Tertiary Care Hospital in Bangladesh. DhakaShishu (Children) Hospital Journal, 35, 9-13. https://doi.org/10.3329/dshj.v35i1.51702
[23]
Gebremichael, B., Abebaw, T., Moges, T., Abaerei, A.A. and Worede, N. (2018) Predictors of Pediatric Tuberculosis in Public Health Facilities of Bale Zone, Oromia Region, Ethiopia: A Case Control Study. BMC Infectious Diseases, 18, Article No. 252. https://doi.org/10.1186/s12879-018-3163-0
[24]
Gupta, N., Kashyap, B., Dewan, P., Hyanki, P. and Singh, N.P. (2019) Clinical Spectrum of Pediatric Tuberculosis: A Microbiological Correlation from a Tertiary Care Center. Journal of Tropical Pediatrics, 65, 130-138. https://doi.org/10.1093/tropej/fmy026
[25]
Deosthali, A., Donches, K., Delvecchio, M. and Aronoff, S. (2019) Etiologies of Pediatric Cervical Lymphadenopathy: A Systematic Review of 2687 Subjects. Global Pediatric Health, 6. https://doi.org/10.1177/2333794X19865440
[26]
Khuawar, S.M., Laghari, A.H. and Shaikh, G.S. (2019) Tuberculosis as a Predicator of Childhood Malnutrition in Sindh, Pakistan. National Editorial Advisory Board, 30, 32.
[27]
Andronikou, S., Grier, D. and Minhas, K. (2020) Reliability of Chest Radiograph Interpretation for Pulmonary Tuberculosis in the Screening of Childhood TB Contacts and Migrant Children in the UK. Clinical Radiology, 76, 122-128.
[28]
Shah, I., Shetty, N.S., Goyal, A., Patankar, N., et al. (2020) Clinical Profile of Tuberculosis in Children. Medical Journal of Dr DY Patil Vidyapeeth, 13, 43. https://doi.org/10.4103/mjdrdypu.mjdrdypu_89_19
[29]
Planting, N.S., Visser, G.L., Nicol, M.P., Workman, L., Isaacs, W. and Zar, H.J. (2014) Safety and Efficacy of Induced Sputum in Young Children Hospitalised with Suspected Pulmonary Tuberculosis. The International Journal of Tuberculosis and Lung Disease, 18, 8-12. https://doi.org/10.5588/ijtld.13.0132
[30]
Hesseling, A.C., Schaaf, H.S., Gie, R.P., Starke, J.R. and Beyers, N. (2002) A Critical Review of Diagnostic Approaches Used in the Diagnosis of Childhood Tuberculosis. The International Journal of Tuberculosis and Lung Disease, 6, 1038-1045.
[31]
World Health Organization (2015) Implementing the End TB Strategy: The Essentials.
[32]
World Health Organization (2020) Molecular Assays Intended as Initial Tests for the Diagnosis of Pulmonary and Extrapulmonary TB and Rifampicin Resistance in Adults and Children: Rapid Communication.
