Special drive against TB in children


The State branch of the Indian Academy of Paediatrics (IAP) has taken up a special drive to implement protocol-based and standardised management of all paediatric TB cases in the State to ensure that all children are TB-free much before the State achieves the 2025 target of total TB elimination.

Paediatric TB cases have been declining rapidly in the State, registering an annual decline of 7.5%. In the past one decade, cases have dropped by one-third. Out of the 6,133 suspected paediatric TB samples tested using CBNAAT in 2019, only 1%, 65 cases, turned out to be positive for TB. At the national level, this rate is 10%.

However, one of the main trends in paediatric TB in the State has been the wide variation in the rates across districts, with inexplicably high proportion of child TB cases in some districts .

“We found that Malappuram and Wayanad have been reporting nearly five times the number of child cases reported by Alappuzha or Idukki. About 19 out of every 100 TB cases in Malappuram are under 14 years. This figure was 16 for Wayanad, 10 for Kasaragod and nine for Kannur. These figures are inexplicably high,” a senior National Tuberculosis Elimination Programme (formerly Revised National Tuberculosis Control Programme) official said.

The problem was that there was no uniformity in the manner of diagnosis or treatment. Doctors were in all likelihood over-treating children with TB drugs, to be on the safe side, probably because the Mantoux tuberculin skin test was positive (Mantoux test only indicates infection or latent TB, not an active disease state).

“This lack of uniformity in treatment is one of the main issues that IAP intends to tackle this year through a special project, ‘TB-free air for every child in Kerala.’ We are planning to implement protocol-based, standardised management of paediatric TB cases across the State. All our 2,500-odd paediatricians will be trained in the treatment protocol,” IAP State president M. Narayanan said.

Diagnosing TB in children is difficult, because most children cannot produce a sputum sample which can be sent for microbiological analysis. At present, most children are treated for TB presumptively, on the basis of clinical diagnosis alone, rather than through a microbiological confirmation.

The proportion of microbiologically confirmed cases amongst the total paediatric TB cases has been found to be low at just 10% in the State, especially among districts which reported high proportion of paediatric cases.

“IAP paediatric TB guidelines recommend that every attempt must be made to microbiologically confirm diagnosis in children by collecting gastric lavage samples from the stomach by inserting a Ryle’s tube through the nose. We have initiated training programmes for nurses across the State on proper sample collection, so that all districts are encouraged to ensure microbiological confirmation of paediatric TB cases,” Dr. Narayanan said.

Cough etiquette

The IAP will also campaign for addressing some of the determinants of TB such as malnutrition in children and tobacco smoking by adults. Encouraging children to practise cough etiquette and using handkerchiefs and ensuring complete treatment of adults with TB are part of the IAP initiative.

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Printable version | Jan 28, 2020 11:20:32 PM |

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