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Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab

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Show simple item record Safdar, Nauman eng Hinderaker, Sven Gudmund eng Baloch, Noor Ahmed eng Enarson, Donald Arthus eng Khan, Muhammad Amir eng Mørkve, Odd eng 2011-09-16T11:48:54Z 2011-09-16T11:48:54Z 2010-11-30 eng
dc.identifier.issn 1756-0500 eng
dc.description.abstract <p>Background: The adherence to policies of National TB Control Programme (NTP) to manage a case of tuberculosis (TB) is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines.</p> <p>Findings: An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05) and two years post-intervention (2006-07) after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown), and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown). Diagnostic scores were recorded for only a minority of cases (18%). The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27%) in pre-intervention and in 483 out of 551 cases (87%) post-intervention, all among the 692 cases without documented treatment supporter.</p> <p>Conclusions: The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case management practices remained inadequate. This seems to increase case finding substantially but the treatment outcomes were poor mainly due to unknown outcomes. Development and implementation of standardized operational tools and regular monitoring system may improve the services.</p> en_US
dc.language.iso eng eng
dc.publisher BioMed Central eng
dc.relation.ispartof <a href="" target="_blank">Childhood tuberculosis case management in Pakistan: Addressing a priority</a> eng
dc.rights Attribution CC BY eng
dc.rights.uri eng
dc.title Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab eng
dc.type Journal article eng
dc.subject.nsi VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Lung diseases: 777 eng
dc.rights.holder Copyright 2010 Safdar et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.type.version publishedVersion eng
bora.peerreviewed Peer reviewed eng
bora.journalTitle BMC Research Notes eng
bibo.volume 3 eng
bora.cristinID 531055 eng
bibo.number 324 eng
bibo.doi eng
dc.identifier.cristinID 531055 eng

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