How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study

Abstract Background In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support....

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Main Authors: Aashifa Yaqoob, Sven Gudmund Hinderaker, Razia Fatima, Hina Najmi, Anwar-ul-Haq
Format: Article
Language:English
Published: BMC 2021-01-01
Series:BMC Public Health
Subjects:
Online Access:https://doi.org/10.1186/s12889-020-10053-4
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spelling doaj-26dadac59a2b4ab498466412736f64772021-01-10T12:05:29ZengBMCBMC Public Health1471-24582021-01-012111910.1186/s12889-020-10053-4How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional studyAashifa Yaqoob0Sven Gudmund Hinderaker1Razia Fatima2Hina Najmi3Anwar-ul-Haq4Common Management Unit (HIV/AIDS, TB & Malaria)University of BergenCommon Management Unit (HIV/AIDS, TB & Malaria)Health Services AcademyMinistry of National Health Services Regulation & Coordination, Government of PakistanAbstract Background In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support. However, diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods We used a cross-sectional study, which was based on a national survey measuring under-reporting of children with TB in 12 selected districts in Pakistan from April–June, 2016. We explored the practices of the private health care providers, including the health care workers i.e. general practitioners, pediatricians, pulmonologists and chest specialists, who were involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB. Results Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG (Bacillus Calmette–Guérin) scar was more common in female children. Private providers relied on chest X-ray in 46.1%, while tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP). Conclusion This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but the cases identified in these investigations were often not notified to the NTP. This problem could be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.https://doi.org/10.1186/s12889-020-10053-4ChildrenTuberculosisPrivate providersManagement practicesReferralDiagnosis
collection DOAJ
language English
format Article
sources DOAJ
author Aashifa Yaqoob
Sven Gudmund Hinderaker
Razia Fatima
Hina Najmi
Anwar-ul-Haq
spellingShingle Aashifa Yaqoob
Sven Gudmund Hinderaker
Razia Fatima
Hina Najmi
Anwar-ul-Haq
How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study
BMC Public Health
Children
Tuberculosis
Private providers
Management practices
Referral
Diagnosis
author_facet Aashifa Yaqoob
Sven Gudmund Hinderaker
Razia Fatima
Hina Najmi
Anwar-ul-Haq
author_sort Aashifa Yaqoob
title How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study
title_short How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study
title_full How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study
title_fullStr How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study
title_full_unstemmed How do private practitioners in Pakistan manage children suspected having tuberculosis? A cross sectional study
title_sort how do private practitioners in pakistan manage children suspected having tuberculosis? a cross sectional study
publisher BMC
series BMC Public Health
issn 1471-2458
publishDate 2021-01-01
description Abstract Background In Pakistan, private providers provide a large portion of health care, including for tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision, and support. However, diagnosis of TB in children is difficult. We aimed to assess the private health care providers’ investigation practices and management of childhood TB. Methods We used a cross-sectional study, which was based on a national survey measuring under-reporting of children with TB in 12 selected districts in Pakistan from April–June, 2016. We explored the practices of the private health care providers, including the health care workers i.e. general practitioners, pediatricians, pulmonologists and chest specialists, who were involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB. Results Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Only 187(2.9%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. Failure to thrive, loss of body weight and absence of BCG (Bacillus Calmette–Guérin) scar was more common in female children. Private providers relied on chest X-ray in 46.1%, while tuberculin skin test and Gene-Xpert MTB/RIF testing was little utilized. Bacteriological confirmation was present in 7.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, only 955(14.6%) children were treated by private provider, while 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre (NTP). Conclusion This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but the cases identified in these investigations were often not notified to the NTP. This problem could be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.
topic Children
Tuberculosis
Private providers
Management practices
Referral
Diagnosis
url https://doi.org/10.1186/s12889-020-10053-4
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