Treatment of paediatric tuberculosis (TB) in Kerala is getting streamlined with the Indian Academy of Paediatrics (IAP) launching a major six-point initiative on Sunday to ensure that paediatric TB diagnosis is standardised and uniform and that latent TB infection in children is tackled through preventive therapy for all vulnerable or at-risk children.
The initiative, called TB-free Air for Every Child in Kerala, is being launched by IAP in partnership with National TB Elimination programme and the State TB Cell, to raise awareness on children’s right to breathe clean air.
A major highlight of the initiative is IAP’s decision to introduce a peer audit system for diagnosis of paediatric TB, so that uniform high standards of TB care to all children in public and private sector can be ensured.
“Diagnosis of paediatric TB is fraught with much confusion and challenges as collecting sputum samples from children for microbiological analysis is difficult. At present, most paediatricians go by clinical diagnosis for a presumptive diagnosis of TB in children, rather than a proper microbiological analysis,” a senior Health official said.
This lack of uniformity in diagnosis has been creating various issues, including the likelihood of over diagnosis of TB in children. This suspicion had surfaced because of the wide disparity in the rate of Paediatric TB in some districts, with the rates remaining inexplicably high in certain districts.
It is possible that at least in some instances, paediatricians might have prescribed TB drugs to those children who tested positive in the Mantoux tuberculin skin test as a precaution, even though Mantoux test is not an indication of active disease.
“Which is why IAP’s decision to subject every diagnosis of paediatric TB in the State to peer auditing by a committee of experts should be seen as a bold initiative because it will usher in uniform protocols for diagnosis and standardised care of paediatric TB ,” he added.
The decision is important in the context of the State’s fight against antimicrobial resistance too.
IAP is also partnering with the Health department’s Latent TB Infection (LTBI) management initiative wherein, all children, in households where a case of pulmonary TB has been diagnosed, will be tested for latent TB infection and given preventive therapy to prevent the infection from becoming active TB. Kerala is the first State in the country to draw up an action plan to manage LTBI
Latent TB is a condition wherein a person might be infected by the TB bacteria but the infection remains latent and becomes an active TB case only when the immunity drops.
An estimated 20,000 such children till 15 years of age at risk of TB, including those with diminished immune status because of cancer, renal diseases or HIV will be tested and given preventive TB therapy. The State estimates that 2,000 cases of active childhood TB could be averted every year through this initiative.
The other activities in the six-point anti-TB initiative include training all 2,500 paediatricians in Kerala on TB elimination guidelines, training nurses to administer TB test and to collect proper samples, mobilising community against malnutrition and tobacco habit and promoting respiratory hygiene amongst children
