01 Apr Pakistan: The Indus Hospital screens children for TB at tertiary care hospitals
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”2632,2633″ img_size=”full”][vc_column_text]In 2016 the Indus Hospital (TIH) initiated TB screening of children aged 15 or younger at larger public and private tertiary care hospitals in densely populated areas in Karachi, Peshawar, Lahore, and Quetta. Trained doctors and nurses have been placed in major pediatric outpatient departments (OPDs) to actively screen, test and treat children with TB.
The intervention started in the city of Karachi – where case notification is low amongst its population of about 20 million – and has more recently been progressively expanded to the cities of Peshawar (2017), Lahore (2017) and Quetta (2018).
The overall objective of the intervention is to detect TB in children who are either missed or in the early stages of the disease. Private practitioners are often the first line of healthcare providers in communities, and due to their varying knowledge and thus capacity to detect TB, many patients – including children – may suffer TB symptoms for years before reaching an accurate diagnosis. Screening of children in pediatric OPDs and wards has helped identify presumptive TB patients quicker and more effectively. To avoid loss to follow up, project staff closely follows children to ensure a successful treatment outcome.
The Childhood TB program responds both to the lack of systematic infrastructure to search and accurately identify childhood TB, especially in public tertiary care hospitals, and to the critical gap in capacity amongst primary and secondary care providers to diagnose children with TB.
The program provides an active screening element by rapid symptomatic and risk factor screening amongst children already visiting OPDs – not necessarily with TB-related complaints. It also allows for active diagnosis of child contacts of TB patients being treated at each facility.
The intervention which is the first of its kind in Pakistan has been successful in increasing the number of children diagnosed with TB at these hospitals.
Since July 2016, 583’744 children have been screened across four cities; 17’978 were tested and 8’102 were diagnosed with TB, out of which 7,911 children were put on treatment. In Peshawar, reported TB cases in 2018 increased by 113% compared to 2016, while in Karachi the increase over the same period of time was 59%.
The childhood TB program has been active since 2016. During this time data has been captured using a mobile-based data collection application. The program uses this data to further optimize children identification at various stages of the patient flow, enhance patient yield, improve efficiency, enable rapid and early identification of missing cases and impact case notification. Contact management has also been enhanced to improve case detection.
Difficult cases are diagnosed by consultations with pediatric TB experts and senior pediatricians who regularly conduct clinical reviews and audits with project staff to prevent inaccurate diagnosis.
In the coming months, The Indus Hospital will focus on reducing loss to follow up during the diagnosis cycle and treatment, and ensuring 100% treatment completion.[/vc_column_text][/vc_column][/vc_row]