Intensified tuberculosis case finding among malnourished children in nutritional rehabilitation centres of Karnataka, India: missed opportunities.
Intensified tuberculosis case finding among malnourished children in nutritional rehabilitation centres of Karnataka, India: missed opportunities.
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DOI：
10.1371/journal.pone.0084255
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Reid AJ
中科院分区：
文献类型：
--
作者：
Bhat PG;Kumar AM;Naik B;Satyanarayana S;Kg D;Nair SA;Md S;Heldal E;Enarson DA;Reid AJ
严重急性营养不良（SAM）是影响五岁以下儿童的最严重的营养不良形式，与包括结核病（TB）在内的许多传染病有关。在印度，最近建立了营养康复中心，以管理包括结核病在内的严重营养不良。印度国家结核病规划（NTP）推出了一种经修订的儿科结核病诊断算法。我们的目的是检查NRC在诊断SAM儿童结核病时是否遵守这些指南。一项横断面研究，涉及审查2012年期间印度卡纳塔克邦6个有NRC（人口：180万）的tehsil（分区）卫生工作者确定的所有SAM儿童的记录。在1927名确定的SAM儿童中，有1632名（85%）到达了NRC。其中，1173例（72%）接受了结核病评估，19例（2%）被诊断为结核病。在1173例中，460例（37%）遵循了诊断算法。在其余763例未按照算法进行评价的患者中，307例（41%）仅进行了结核菌素皮肤试验，99例（13%）仅进行了胸部X线摄影，337例（45%）未进行任何检查。根据算法评估的儿童中TB的发生率（4%）高于未评估的儿童（0.3%）（OR：15.3 [95%CI：3.5-66.3]）。观察到几个业务挑战，包括没有全职儿科医生，由于频繁停电而无法使用X光机，使用次优强度的结核菌素以及难以遵守复杂的诊断算法。 这项研究表明，在卡纳塔克邦，自然资源中心的结核病筛查是次优的。一些儿童没有接触到NRC，而许多接触过的儿童要么没有接受结核病评估，要么接受了次优评估。这项研究指出，如果这一合作战略要在印度营养不良儿童中发现更多的结核病病例，就需要解决一些操作问题。
Severe acute malnutrition (SAM) is the most serious form of malnutrition affecting children under-five and is associated with many infectious diseases including Tuberculosis (TB). In India, nutritional rehabilitation centres (NRCs) have been recently established for the management of SAM including TB. The National TB Programme (NTP) in India has introduced a revised algorithm for diagnosing paediatric TB. We aimed to examine whether NRCs adhered to these guidelines in diagnosing TB among SAM children. A cross-sectional study involving review of records of all SAM children identified by health workers during 2012 in six tehsils (sub-districts) with NRCs (population: 1.8 million) of Karnataka, India. Of 1927 identified SAM children, 1632 (85%) reached NRCs. Of them, 1173 (72%) were evaluated for TB and 19(2%) were diagnosed as TB. Of 1173, diagnostic algorithm was followed in 460 (37%). Among remaining 763 not evaluated as per algorithm, tuberculin skin test alone was conducted in 307 (41%), chest radiography alone in 99 (13%) and no investigations in 337 (45%). The yield of TB was higher among children evaluated as per algorithm (4%) as compared to those who were not (0.3%) (OR: 15.3 [95%CI: 3.5-66.3]). Several operational challenges including non-availability of a full-time paediatrician, non-functioning X-ray machine due to frequent power cuts, use of tuberculin with suboptimal strength and difficulties in adhering to a complex diagnostic algorithm were observed. This study showed that TB screening in NRCs was sub-optimal in Karnataka. Some children did not reach the NRC, while many of those who did were either not or sub-optimally evaluated for TB. This study pointed to a number of operational issues that need to be addressed if this collaborative strategy is to identify more TB cases amongst malnourished children in India.
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影响因子：
2.3
作者：
Kumar, Ashok;Gupta, Devesh;Prasad, Jagadish
通讯作者：
Prasad, Jagadish
影响因子：
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作者：
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通讯作者：
Katona-Apte, Judit
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168.9
作者：
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Raviglione, Mario C.
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作者：
de Onis, Mercedes;Onyango, Adelheid;Lutter, Chessa
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Lutter, Chessa