Improving screening and chemoprophylaxis among child contacts in India's RNTCP: a pilot study

Rekha, Banu; Jagarajamma, K; Chandrasekaran, Venkat; Wares, Fraser; Sivanandham, Ranjit; Swaminathan, Subramanian

doi:10.5588/ijtld.12.0415

Cited by 34 publications

(30 citation statements)

References 9 publications

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“…In South Africa it was demonstrated that after the implementation of an IPT register, documented identification of child contacts, IPT initiation and adherence in TB exposed children has improved [19]. Similarly studies in India also shown improved contact screening and chemoprophylaxis and HCWs expressed satisfaction with the use of IPT card and register saying that it helped them to remember to complete required tasks [20,21]. Therefore, introduction of user friendly formats to monitor contact screening and management need to be considered and prioritized by the TB control program.…”

Section: Discussionmentioning

confidence: 99%

Cross Sectional Study Evaluating Routine Contact Investigation in Addis Ababa, Ethiopia: A Missed Opportunity to Prevent Tuberculosis in Children

2015

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The 2013 global roadmap for childhood tuberculosis calls for countries to implement contact screening and provide preventive therapy to children younger than 5 years. Therefore, this study designed to evaluate the implementation status of child contact screening and management in the health facilities of Addis Ababa, Ethiopia. Smear positive TB patients living with children attending daily observed treatment at the TB clinic and health care workers providing service were approached to address the study objective. Structured questionnaires were administered to smear positive index cases living with children whether they were requested to bring children age five year and below for TB screening and to health care providers in HIV, TB and child health clinics to assess their knowledge and practice on contact screening and management. Double data entry and analysis was done using EpiData software 3.1. In 27 health centres, 688 smear-positive index tuberculosis patients were approached of whom 203 (29.5%) reported to have children five years and below in their household. A total of 48 (23.6%) index cases had been requested by the health care workers to bring their children for tuberculosis screening and 45 (93.8%) had complied with this request. Of 230 children living with index smear positive tuberculosis patient, 152 (66.1%) were not screened for tuberculosis, 78 (33.9%) children screened, 2 had tuberculosis, 76 screened negative of which 3 (3.8%) received preventive treatment. None of the health care workers indicated to routinely record and report on child contact management. Household child contact screening and preventive intervention was sub-optimal in Addis Ababa. An important opportunity lost to prevent tuberculosis in young children. Training of health care workers, availing simple symptom based screening tool, and proper documentation could improve implementation.

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Section: Discussionmentioning

confidence: 99%

Cross Sectional Study Evaluating Routine Contact Investigation in Addis Ababa, Ethiopia: A Missed Opportunity to Prevent Tuberculosis in Children

2015

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“…The WHO, however, recommends the use of a dedicated IPT register in which to document household contacts details. [25] The positive effects of such a system were demonstrated by studies in India [31] and Cape Town, [32] with more contacts being identified and initiated on IPT, better documentation of information and improved adherence rates. A register may resolve the problems experienced with the disorganised IPT card filing system, allowing easier monitoring of the programme.…”

Section: Researchmentioning

confidence: 99%

An assessment of the isoniazid preventive therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay Health District, Eastern Cape Province, South Africa

2018

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Background. Tuberculosis (TB) is a significant contributor to the international and national burden of disease. Global estimates suggest that there were 10.4 million new cases of TB in 2015. Children accounted for ~10% of these cases, although in South Africa (SA) this figure is thought to be higher. Despite clear evidence that isoniazid preventive therapy (IPT) can reduce the risk of progression from TB infection to disease in TB contacts, IPT has been poorly implemented in SA national TB control programmes. Objectives. To determine current practices regarding the identification and management of child contacts (<5 years of age) at a primary care clinic in the Nelson Mandela Bay Health District, Eastern Cape Province, SA. Methods. A cross-sectional descriptive study was conducted using a retrospective record review of infectious TB index patients aged ≥15 years. Folders of index patients with bacteriologically confirmed pulmonary TB, who started TB treatment between 21 October 2011 and 28 February 2014, were included. A sample size of 246 child contacts was required to obtain adequate power. A 95% confidence interval (CI) was used to determine statistically significant results. Results. Index patient records (N=491) were assessed and 261 child contacts identified. In a high percentage of index patient folders (87.5%; n=430), contacts were documented, although only 0.53 child contacts were identified per index patient. Of the 261 child contacts identified, 184 (70.5%) were screened for TB, 2 started TB treatment and 108/184 (58.7%) started IPT. For the remaining 74 (40.2%) children, there was no documentation of further management. Only 4 (3.7%) children completed the 24-week IPT course. Male patients reported fewer child contacts (χ 2 =7.31; p=0.01; odds ratio (OR) 0.6; 95% CI 0.42 -0.86) and were less likely to bring contacts for screening (χ

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“…WHO also recommended TST and chest radiography for screening childhood contacts for tuberculosis. The implementation of contact screening has been sub-optimal as reported by various studies [2][3][4], in resource constrained settings like India. Scarcity of diagnostic modalities at primary health care levels, lack of awareness among health workers regarding contact screening and low importance given to the reporting of screening related data in the routine reporting formats [2][3][4] were the common reasons reported for poor implementation of contact screening among childhood contacts.…”

Section: Rapid Communicationmentioning

confidence: 99%

“…Rekha et al (2013) reported that in programme settings in Tamil Nadu, a state in India, provision of a separate IPT card and register, significantly improved the implementation of screening and provision of IPT for pediatric TB contacts [3]. Along with emphasis on drug resistance TB and TB/HIV, the much neglected contact screening among childhood contacts deserves attention from the national programmes to achieve global TB control.…”

Section: Rapid Communicationmentioning

confidence: 99%

“…The implementation of contact screening has been sub-optimal as reported by various studies [2][3][4], in resource constrained settings like India. Scarcity of diagnostic modalities at primary health care levels, lack of awareness among health workers regarding contact screening and low importance given to the reporting of screening related data in the routine reporting formats [2][3][4] were the common reasons reported for poor implementation of contact screening among childhood contacts. The recently released WHO guidelines on pediatric TB management recommends that symptom based approach alone is sufficient for screening child contacts [5] thus removing the dependence on TST for contact screening as per previous WHO recommendation.…”

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confidence: 99%

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New WHO Guidelines on Symptom Based Childhood Contact Screening For Tuberculosis: Relevance to National Tuberculosis Program of India

C¹

2014

J Pulm Respir Med

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Globally there is a growing emphasis on efforts to identify and treat the "missed millions" of Tuberculosis (TB) cases. In India, 5% of the new TB cases are in the pediatric age group [1] and studies have reported that 3.2-16.2% of child contacts have TB disease [2]. In view of the susceptibility of younger children to developing TB of increased severity on contact with an active case of tuberculosis, screening of childhood contacts is recommended by the WHO and is also part of most National Tuberculosis Program (NTP) guidelines. Contact screening helps in identifying contacts of all ages with undiagnosed TB disease among the contacts of an index case, and in providing preventive therapy for childhood contacts without TB disease. However, diagnosis of TB in children is often missed due to the complexities in screening and diagnosis under field conditions. According to existing NTP guidelines in India, the diagnosis of TB among child contacts is dependent on Tuberculin Sensitivity Test (TST) and chest radiography apart from strong clinical suspicion. WHO also recommended TST and chest radiography for screening childhood contacts for tuberculosis. The implementation of contact screening has been sub-optimal as reported by various studies [2][3][4], in resource constrained settings like India. Scarcity of diagnostic modalities at primary health care levels, lack of awareness among health workers regarding contact screening and low importance given to the reporting of screening related data in the routine reporting formats [2][3][4] were the common reasons reported for poor implementation of contact screening among childhood contacts. The recently released WHO guidelines on pediatric TB management recommends that symptom based approach alone is sufficient for screening child contacts [5] thus removing the dependence on TST for contact screening as per previous WHO recommendation. The common symptoms listed are cough, fever, anorexia, weight loss, failure to thrive, fatigue and reduced playfulness [5,6]. Though this recommendation is based on a study done in South Africa [6], this approach is simple to implement without dependence on TST and chest radiography, larger number of contacts can be screened and the delay in starting the asymptomatic contacts on Isoniazid Preventive Therapy (IPT) can be reduced.As per new WHO guidelines, only those children found to be symptomatic based on symptom based screening approach will be evaluated using TST and radiography. The prevalence of the symptoms in general in Indian setting among children may be higher especially due to higher levels of under nutrition prevalent in Indian setting [7]. Symptom checklist used in South Africa for contact screening has to be modified for Indian setting as the two settings are different in respect to HIV prevalence and malnutrition levels. Hence, operational research on symptom based screening will be helpful to establish the feasibility and usefulness of these recommendations in Indian settings. Though WHO has made this recommendation as condi...

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Improving screening and chemoprophylaxis among child contacts in India's RNTCP: a pilot study

Abstract: In a programme setting, with HCW training and introduction of specific documentation (IPT card and register), implementation of contact tracing and chemoprophylaxis for child contacts improved from 19% to 61%.

Cited by 34 publications

References 9 publications

Cross Sectional Study Evaluating Routine Contact Investigation in Addis Ababa, Ethiopia: A Missed Opportunity to Prevent Tuberculosis in Children

Cross Sectional Study Evaluating Routine Contact Investigation in Addis Ababa, Ethiopia: A Missed Opportunity to Prevent Tuberculosis in Children

An assessment of the isoniazid preventive therapy programme for children in a busy primary healthcare clinic in Nelson Mandela Bay Health District, Eastern Cape Province, South Africa

New WHO Guidelines on Symptom Based Childhood Contact Screening For Tuberculosis: Relevance to National Tuberculosis Program of India

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