Childhood Tuberculosis and Community Healthcare_Alan Talens_5.8.14
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This document provides guidance on integrating childhood tuberculosis (TB) screening and treatment into existing community-based child health care programs. It emphasizes asking about TB contact for children presenting with cough, fever, HIV, or malnutrition. Existing programs like IMCI and CCM could incorporate checking for TB signs and referring suspected cases. Steps are outlined to advocate updating guidelines, improve quality of care at all levels for childhood TB, strengthen community and health facility partnerships, and integrate TB promotion with other child health practices. The conclusion states that integrating pediatric TB screening and management into community health programs is essential to reduce child deaths from TB.
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Childhood Tuberculosis and Community Healthcare_Alan Talens_5.8.14
- 1. Alan Talens MD, MPH World Renew CORE Group Community Child Health Working Group
- 16. Community Level • Case finding • Treatment support • Advocacy , • Patient /family support , • Coalition building , • Training and supervision Roadmap for Childhood TB: towards zero deaths
- 18. AIM OF GUIDE The Framework for Integrating Childhood TB Into Community –Based Child Health Care • To emphasize the importance of Childhood TB • To stimulate discussion • To move towards early integration of childhood TB into other maternal and child care activities
- 19. Areas for intervention in existing algorithms Ask for TB contact in children with • HIV • cough >21 days • fever >7days • severe malnutrition ‘Flag’ child as TB suspect Identification of TB suspects for referral: TB contact • HIV • ARI • Malnutrition • Signs/symptoms of TB • Signs of 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 Ensure BCG was given Ask for TB contact in child with ARI, malnutrition, TB signs/symptoms TB is hidden in here: cough > 21 days = danger sign
- 20. Existing Community -Based Health Care Frameworks • IMCI ( Integrated Management of Childhood Illness • Community- IMCI • CCM (Community Case Management)
- 21. IMCI Integrated Management of Childhood Illness Component of IMCI • Improving case management skills of health-care staff • Improving overall health systems • Improving family and community health practices
- 24. Underlying principles in Community Based Health Care Integration • Existing referral mechanism to next level of care (TB services) and support mechanisms for CHWs need to be in place. • Start with simple, basic interventions. • Advanced interventions depending on workload and skills of CHW. • Any question asked has to result in clear action taken.
- 25. Steps to Take in Developing Integrated Community –based Health Care models for Childhood TBChildhood TB 1. Advocacy for country adaptation of guidelines and training materials- for IMCI, C-IMCI and CCM and other programs for CHW to include Childhood TB as serious illness. 2. Improve quality of care of childhood TB at first- level public health facilities. 3. Improve quality of care /or recognition of childhood TB of private sector (traditional healers, private doctors ,drug distributors)
- 26. Steps to Take in Developing Integrated Community –based Health Care models for Childhood TBChildhood TB 4. Improve partnership between health facilities or services and the communities they serve. 5. Increase appropriate, accessible care of and information on childhood TB from the Community- based providers. 6. Integrate promotion of key family practices critical for childhood TB together with child health (Immunization, breastfeeding, HIV and Infection control)
- 27. Conclusion Childhood TB is often an undiagnosed illness contributing to significant global child morbidity and mortality. Integration of Pediatric TB in all levels, most especially at the community health level is a must towards zero TB deaths in children
Editor's Notes
- My presentation is to support the need for the integration of PedTB with Community Based Health Care. Many articles came out on Pediatric TB as a neglected issue because case detection is a challenge and thus cases are under-reported. An article on Childhood TB in Tanzania in 2012–where there is high incidence of adult TB showed that primary health care workers consider pediatric TB as uncommon and not included in the differential diagnosis. Many articles also showed that one reason for difficulty of diagnosis of PedTB is that many TB symptoms overlap with common childhood –such as pneumonia and malnutrition.
- I would really like to have this [It’s not complicated] as title of my presentation but I think AT&T beat me into it with their commercial with children.
- Can’t forget this boy brought in for symptoms like a stroke in adult paralysis of one side and drooping of eyelid; CSF compatible with TB.
- There is a need to lower and widen the safety net at the community level for case finding, treatment support, advocacy , training and supervision of health workers; and also to raise awareness in communities where people have likelihood of getting TB to generate demands for diagnosis , treatment and care.
- We now have the guidelines to deal with Pediatric TB ; and framework for integrating childhood TB into CBHC.
- Aim of the guide is to emphasize the importance of pedtB; to stimulate discussion and to move towards intergration of pedTB and MCH activities.
- Algorythm
- There are several community strategies or framework to use in the CBC PedTB integration
- Pediatric TB could be part of the C-IMCI with 3 element-linkage of community with facility (referral process) ; provision of information and services in community by health workers and improving behavior in household for preventing TB or early diagnosis or treatment. And multi-sectoral approach – awareness advocacy in school, churches etc.
- It could be part of CCM (community case management ) not to diagnose and treat but for CHW recognize , refer and then be part of the IPTs and DOTS by partnering and providing support to families of children with PedTB
- There are a few basic principle on Community BHC integration –remember K.I.S.S.
- There are the steps to take- advocacy for adaptation of PedTB in country mechanism for IMCI, C-IMCI or CCM ; 2) improved quality of in the facilities and improve quality of care of the private sector – tradional healer, doctors and drug distributors.
- Childhood TB is often undiagnosed not because it is difficult to recognize PedTB but rather there is lack of awareness; and integration of pediatric TB in all levels –most especially at the community level is a must towards zero deaths in children.
- Thank you.