Faculty of Public Health - Andalas University - OCS, 13th IEA SEA Meeting and ICPH - SDev

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Determinants of prevalence adherence to RNTCP diagnosis guidelines and outcome of Tuberculosis among severely acute malnourish children admitted to nutritional rehabilitation centres of Madhya Pradesh, India
Bhavna Dhingra, Akash Ranjan Singh, Amber Kumar

Last modified: 2018-08-07

Abstract


Background & Objective: The admission of Severely Acute Malnourished (SAM) children in Nutrition Rehabilitation Centers (NRC) provides an opportunity window for screening and Management of TB at early stage. Present study was planned to estimate the burden of TB and adherence of diagnostic guidelines for its screening. We also explored the health system challenges for the screening of Tuberculosis among SAM children admitted at NRCs of Madhya Pradesh (MP) India 2017.

Methodology: It was an explanatory type of mixed-method study. The setting was Sagar and Sheopur districts of MP state and it was carried out in February to April 2018. In quantitative phase of study, the information pertaining to screening of SAM children as per diagnostic algorithm was obtained through record review, by visiting all 10 NRCs of these districts. After analysis of quantitative phase, the health system challenges were explored through interview guide, by conducting 3 FGDs and 3 Key Informant interviews of important stake holders i.e.; NRC staff, NRC paramedical workers, TB programmes staff, Pediatrician and District TB Officer.

Result: Of the 3,230 children admitted, 63% were identified and referred from Anganwadi centers, 11% by community (i.e. doctors, paramedical workers, NGO etc.) and for 26%, the source of referral was not recorded. The Number of children screened for TB as per NRC diagnostic algorithm was 1.7% (55/3,230) however a total of 6.5% (209/3,230) children diagnosed as having TB disease. Of these 209, the microbiologically confirm (CbNAAT positive) were 23. However, all these 209 diagnosed TB cases were initiated Anti tubercular treatment (ATT) and the median time of start of treatment was less than a week. The most common challenges of healthcare system identified were poor knowledge due to ineffective training, poor record keeping, inadequate resources (i.e. Thin human resource, lack of diagnostic facilities and language barrier) and operationally non-feasibility of diagnostic modalities.

Conclusion & recommendation: Present evaluation study reported 6.5% prevalence of TB among SAM children admitted at NRC. Overemphasis on clinical diagnosis that too mountoux test should be the area of concern. Quality and effective training (based on Kirkpatrick Model), ensuring availability of adequate resources, more use of hindi language for documentation and simplifying and making more feasible diagnostic algorithm can improve the diagnosis and management of TB in SAM children admitted at NRC.