Diagnosis of childhood tuberculosis in Pakistan: Are national guidelines used by private healthcare providers?. (June 2021)

• Record Type: Journal Article
• Authors: Yaqoob, Aashifa; Hinderaker, Sven Gudmund; Fatima, Razia; Shewade, Hemant D.; Nisar, Nadia; Wali, Ahmed
• Is Part Of: International journal of infectious diseases. Volume 107(2021)
• Page Start: 291
• Page End: 297
• Publication Date: 2021-06
• Subjects: Tuberculosis -- Children -- Diagnosis -- Guidelines -- PPA scoring chart -- Private providers -- Pakistan; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.04.055
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Evaluation of childhood tuberculosis (TB) diagnosis by private healthcare providers. Highlighted low utilization of the national guidelines for childhood TB diagnosis. Less than 50% of private healthcare providers followed the guidelines. Better training and expansion of public-private partnerships could improve take-up. Abstract: Background: The National Tuberculosis Control Program (NTP) in Pakistan developed, with the Pakistan Paediatric Association, a pediatric scoring chart to aid diagnosis of childhood tuberculosis (TB). Our study compared the diagnostic practice of private healthcare providers in Pakistan with the NTP guidelines. Methods: A cross-sectional study comparing diagnosis of TB in children <15 years by Non-NTP private providers with the NTP's pediatric scoring chart. A generalized linear model was used to determine the difference in adherence by Non-NTP private providers to the NTP guidelines for childhood TB diagnosis by associated factors. Results: A total of 5193 (79.7% of presumptive childhood TB cases identified in the selected districts during the study) children were diagnosed with TB by Non-NTP private providers. A strong clinical suspicion of TB was present in 17.3%, and chest x-ray was suggestive of TB in 34.3%. The Kappa score between Non-NTP private providers and the NTP guidelines for diagnosing TB was 0.152. Only 47.8% of cases were diagnosed in line with the NTP guidelines. Children <5 years old with a history of TB contact had a higher chance of being diagnosed according to the NTP guidelines. Conclusion: This study indicates a low adherence of NTP guidelines for diagnosing childhood TB by private providers in Pakistan.