K S Sahana, Saldanha Prakash R M, Kushwah Supriya, Prabhu Anitha S
Yenepoya Medical College and University, India.
Yenepoya Medical College and University, India.
Indian J Tuberc. 2018 Jul;65(3):195-199. doi: 10.1016/j.ijtb.2018.02.002. Epub 2018 Feb 21.
In spite of having BCG vaccination and tuberculosis control program for the last 50 years, prevalence of tuberculosis continues to be high in India. Inadequate diagnostic methods, suboptimal treatment and monitoring, and the lack of vigilant reporting system are some of the contributing factors for the failure of TB control.
To know the current practices among local pediatricians regarding management of TB.
Field based cross sectional study. All the registered pediatricians who were practicing in Mangalore, (list - local IAP branch) were included in the study. A structured Questionnaire on signs and symptoms of TB, diagnosis, strategies adopted in treatment, MDR tuberculosis and reporting of cases to RNTCP was asked. Management practice standards according to the Updated National Guidelines for Pediatric Tuberculosis in India, 2012, RNTCP guidelines in consensus with IAP, latest at the time of the study.
50 pediatricians participated in the study with 62% having an attachment to the teaching institution. More than 50% identified all the symptoms of TB. 64% were sending chest X-ray, Mantoux test and gastric lavage/induced sputum examination for AFB to diagnose TB. 22% were not stressing for AFB examination. Still 16% told serological tests as one of the diagnostic modality. 52% were not aware about the diagnosis of latent TB. In 16% of their cases ATT was on a trial basis. Only 52% of the clinicians are adhering to updated national (RNTCP) guidelines. 30% felt still there are drawbacks in the current RNTCP guidelines. 72% knew the correct definition of MDR tuberculosis. But only 36% of them knew the diagnostic method (gene expert/CB NAAT) of confirming the MDR TB.
Management practices are found to be still suboptimum. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.
尽管在过去50年里实施了卡介苗接种和结核病控制计划，但印度的结核病患病率仍然很高。诊断方法不足、治疗和监测不理想以及缺乏警惕的报告系统是结核病控制失败的一些促成因素。
了解当地儿科医生在结核病管理方面的当前做法。
基于现场的横断面研究。所有在芒格洛尔执业的注册儿科医生（名单 - 当地印度儿科学会分会）都被纳入研究。就结核病的体征和症状、诊断、治疗中采用的策略、耐多药结核病以及向国家结核病控制规划报告病例等方面询问了一份结构化问卷。根据2012年印度儿科结核病最新国家指南、与印度儿科学会达成共识的国家结核病控制规划指南（研究时的最新版本）制定管理实践标准。
50名儿科医生参与了研究，其中62%与教学机构有联系。超过50%的人能识别出所有结核病症状。64%的人会进行胸部X光、结核菌素试验以及胃灌洗/诱导痰涂片找抗酸杆菌检查以诊断结核病。22%的人不强调抗酸杆菌检查。仍有16%的人将血清学检测作为诊断方法之一。52%的人不知道潜伏性结核病的诊断方法。在他们的病例中，16%的抗结核治疗是试验性的。只有52%的临床医生遵循最新的国家（国家结核病控制规划）指南。30%的人认为当前的国家结核病控制规划指南仍有缺陷。72%的人知道耐多药结核病的正确定义。但其中只有36%的人知道确认耐多药结核病的诊断方法（基因专家检测/环介导等温扩增技术）。
发现管理实践仍未达到最佳状态。迫切需要私营部门更好地参与，以改善结核病管理实践，防止诊断延误和耐药性。
