Government Medical College, Shahdol, India.
All India Institute of Medical Sciences (AIIMS), Bhopal, India.
PLoS One. 2021 Mar 12;16(3):e0248192. doi: 10.1371/journal.pone.0248192. eCollection 2021.
In India, under-five children with Severe Acute Malnutrition (SAM) are referred to Nutritional Rehabilitation Centers (NRCs). NRCs screen the causes of SAM including tuberculosis (TB). The national TB programme recommends upfront testing with a rapid molecular test if TB is suspected in children.
We estimated the yield of and adherence to the TB diagnostic guidelines (clinical assessment and assessment for microbiological confirmation) among under-five children with SAM admitted at NRCs (six in district Sagar and four in district Sheopur) of Madhya Pradesh, India in 2017. We also explored the challenges in screening from the health care providers' perspective.
It was an explanatory mixed method study. The NRC records were reviewed This was followed by three key informant interviews and three focus group discussions among staff of NRC and TB programme. Manual descriptive thematic analysis was performed.
Of 3230, a total of 2665(83%) children underwent Mantoux test, 2438(75%) underwent physical examination, 2277(70%) were asked about the symptoms suggestive of TB, 1220(38%) underwent chest radiograph and 485(15%) were asked for recent contact with TB. A total of 547(17%) underwent assessment for microbiological confirmation. Of 547, a total of 229 gastric aspirate specimens underwent rapid molecular test (24% positive) and 318 underwent sputum microscopy (44% positive). A total of 223 were diagnosed as TB (195 microbiologically and 28 clinically confirmed) and 209 were initiated on anti-TB treatment. The treatment outcome was favourable (cure or treatment completed) for 70(31%) and not recorded for 121(54%). The main perceived challenges in screening for TB were poor team skills, lack of diagnostic facilities and poor understanding of the guidelines due to inadequate training.
Though NRCs provided a unique window of opportunity for the screening and management of TB among under-five children with SAM, the utilization of this opportunity remained suboptimal.
在印度，五岁以下患有严重急性营养不良（SAM）的儿童被转介到营养康复中心（NRC）。NRC 筛查 SAM 的病因，包括结核病（TB）。国家结核病规划建议，如果怀疑儿童患有结核病，应立即进行快速分子检测。
我们评估了 2017 年印度中央邦萨格尔区（six in district Sagar）和谢普尔区（four in district Sheopur）的 NRC 收治的五岁以下 SAM 儿童（共 3230 名儿童）中采用结核病诊断指南（临床评估和微生物学确认评估）的效果，并评估了从卫生保健提供者的角度来看筛查所面临的挑战。
这是一项解释性混合方法研究。我们查阅了 NRC 记录，随后对 NRC 和结核病规划工作人员进行了三次关键知情人访谈和三次焦点小组讨论。采用手工描述性主题分析。
在 3230 名儿童中，共有 2665 名（83%）儿童接受了结核菌素试验，2438 名（75%）儿童接受了体格检查，2277 名（70%）儿童被问及有结核病症状，1220 名（38%）儿童接受了胸部 X 光检查，485 名（15%）儿童被问及最近是否与结核病患者接触。共有 547 名（17%）儿童接受了微生物学确认评估。在 547 名儿童中，共有 229 份胃液抽吸标本接受了快速分子检测（24%阳性），318 份接受了痰显微镜检查（44%阳性）。共有 223 名被诊断为结核病（195 名经微生物学证实，28 名经临床证实），并开始接受抗结核治疗。209 名（70%）治疗结局良好（治愈或治疗完成），121 名（54%）治疗结局未记录。筛查结核病的主要感知挑战是团队技能差、缺乏诊断设施以及由于培训不足导致对指南的理解不足。
尽管 NRC 为五岁以下 SAM 儿童提供了筛查和管理结核病的独特机会，但对这一机会的利用仍不理想。
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