According to the Revised National Tuberculosis Control Program (RNTCP) 2014 status report, nearly five per cent of new cases in India are reported among children. With such a huge number, early detection and treatment hold the key to prevent mortality and limit morbidity, said the authors of the study.
A cross-sectional study done by the Tata Institute of Social Sciences (TISS) on childhood pulmonary tuberculosis (TB) management has revealed a high incidence of inappropriate diagnostic and treatment practices among paediatricians in the private sector.
According to the Revised National Tuberculosis Control Program (RNTCP) 2014 status report, nearly five per cent of new cases in India are reported among children. With such a huge number, early detection and treatment hold the key to prevent mortality and limit morbidity, said the authors of the study.
The study, which was published in the latest issue of Interdisciplinary Perspectives on Infectious Diseases journal, had interviews of private paediatricians practising across Mumbai. The study was carried out from December 2012 to February 2014 and a total of 644 doctors were approached.
"This survey revealed that diagnostic and treatment practices in management of childhood pulmonary TB among paediatricians in Mumbai's private sector deviated from practices recommended by the International Standards for Tuberculosis Care (ISTC) 2009," said Nilesh Gawde, who co-authored the survey with Carolyn Kavita Tauro. He added, "Most TB patients are still receiving care from a large variety of providers outside the national TB programme, despite the high cost and varying quality. It is, therefore, important to understand TB care in private sector."
He said the lack of knowledge about treatment regimen and inappropriate prescriptions have been reported across multiple countries. "Prompt diagnosis is one of the basic principles in the management of the disease. In the present study, more than a fifth of paediatricians did not mention cough as a symptom of TB (Standard 1 of ISTC). This is likely to delay diagnosis, and subsequently treatment, with poor outcomes," said Gawde.
The study also highlighted delay in suspecting drug-resistance. "The study revealed that resistance was not suspected in a child even if she/he had a history of prior treatment with anti-tubercular drugs. It was found that patients not responding to treatment were offered another regimen, without investigating for the presence of drug-resistance," he added.
The study also mentioned prescriptions after the diagnosis of multi-drug resistant (MDR) TB were often inadequate, which could compound mono-resistance to MDR to extensively drug-resistant (XDR) TB.
Meanwhile, Dr Yatin Dholakia, secretary of Maharashtra State Anti-TB Association, said paediatricians and other doctors should follow the guidelines formulated by in the Indian Academy of Paediatricians (IAP) along with RNTCP. "Diagnosing TB in children is difficult, as they are not able to clearly tell the symptoms. Their representation of symptoms is very different from that of adults. They do not know how to give a good sample of sputum too.
Doctors should follow the IAP guidelines put up on the RNTCP website."
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