1. Anne Detjen
Devasena
Gnanashanmugam
Alan Talens
for the Child TB interest and
CCH working groups

2. Rationale
• Children with TB are living in the community and are
likely to initially present to primary care services
• Family-centered and community-based care models
can be a platform to support TB case finding, contact
screening, follow-up as well as advocacy and
awareness
• Existing frameworks and modules for community
case management target diseases for which TB is a
differential diagnosis

3. Guiding principles
• Focus on few simple interventions to
– increase the level of suspicion
– identify children at risk
• Basic need: referral mechanisms to next level of care
that can diagnose TB in children
– TB program needs to decentralize care
• Potential to add more complex interventions
depending on
– the skills, workload of HCW and
– local needs

4. Caring for the sick child in the community
Ask for TB contact in children
with
• HIV
• Prolonged cough
• Prolonged fever
• Severe malnutrition
Refer child for presumptive TB
Identification of
presumptive TB for referral:
• TB contact
• HIV
• ARI
• Malnutrition
• Signs/symptoms of
TB/EPTB
Follow-up: Child with TB contact/HIV who does
not improve after treatment of ARI, malaria
and/or who does not gain weight after feeding
supplements should be referred as presumptive
Ensure BCG was given
Ask for TB contact in child with
ARI, malnutrition, TB signs/symptoms

6. Other areas for intervention
• Household contact screening
• Infection control
• Identify potential adult TB cases in a household
• Treatment support
• Preventive services
– Education, awareness
– Make sure newborns received BCG
– TB in pregnant mothers

7. Samira Aboubaker, iCCM Evidence Review Symposium Ghana 2014
WHO/UNICEF modules for community interventions

8. iCCM modules
• Revised iCCM modules will include some basic TB
and HIV interventions (TB contact)
• Pilot testing under discussion in Nigeria and Malawi
• Materials will be shared and discussed during
satellite session at AIDS 2014 conference in
Melbourne

9. How do we make the framework more that just
another document?
• Need some pilot work
– In a TB high burden setting, how many children are
identified as TB suspects if simple questions added to
iCCM algorithms?
– How many children are diagnosed with TB
– How many children are treated for
pneumonia/malnutrition, don’t respond at follow-up and
have other risk factors for TB?
• Anyone interested???
• Stop TB Partnership Childhood TB subgroup has a
wider network of childhood TB specialists around the
world to provide technical assistance

10. In your area of work
• Is TB an issue?
• Could it be an issue?
• Do you know of any ongoing work addressing
childhood TB at the community level?
• Where in your area of work would it make sense to
think about addressing childhood TB – and how?

11. Thank you