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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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dc.contributor.author Safdar, Nauman
dc.contributor.author Hinderaker, Sven Gudmund
dc.contributor.author Baloch, Noor Ahmed
dc.contributor.author Enarson, Donald Arthus
dc.contributor.author Khan, Muhammad Amir
dc.contributor.author Mørkve, Odd
dc.date.accessioned 2011-09-16T11:48:54Z
dc.date.available 2011-09-16T11:48:54Z
dc.date.issued 2010-11-30
dc.identifier.citation BMC Research Notes 3(324) en_US
dc.identifier.issn 1756-0500 (print version)
dc.identifier.uri http://hdl.handle.net/1956/5014
dc.identifier.uri http://dx.doi.org/10.1186/1756-0500-3-324
dc.description.abstract 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. 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. 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. en_US
dc.language.iso eng en_US
dc.publisher BioMed Central en
dc.relation.ispartof <a href="http://hdl.handle.net/1956/5016" target="_blank">Childhood tuberculosis case management in Pakistan: Addressing a priority</a>
dc.rights 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 (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en_US
dc.rights.uri http://creativecommons.org/licenses/by/2.0 en_US
dc.title Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab en_US
dc.type Journal article en_US
dc.type Peer reviewed en_US
dc.subject.nsi VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Lung diseases: 777 en_US
dc.type.version publishedVersion en_US


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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 (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as 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 (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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