Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan; University of Bergen, Bergen, Norway.
University of Bergen, Bergen, Norway.
Int J Infect Dis. 2021 Jun;107:291-297. doi: 10.1016/j.ijid.2021.04.055. Epub 2021 Apr 22.
The National Tuberculosis Control Program (NTP) in Pakistan developed, with the Pakistan Paediatric Association, a pediatric scoring chart to aid diagnosis of childhood tuberculosis (TB). Our study compared the diagnostic practice of private healthcare providers in Pakistan with the NTP guidelines.
A cross-sectional study comparing diagnosis of TB in children <15 years by Non-NTP private providers with the NTP's pediatric scoring chart. A generalized linear model was used to determine the difference in adherence by Non-NTP private providers to the NTP guidelines for childhood TB diagnosis by associated factors.
A total of 5193 (79.7% of presumptive childhood TB cases identified in the selected districts during the study) children were diagnosed with TB by Non-NTP private providers. A strong clinical suspicion of TB was present in 17.3%, and chest x-ray was suggestive of TB in 34.3%. The Kappa score between Non-NTP private providers and the NTP guidelines for diagnosing TB was 0.152. Only 47.8% of cases were diagnosed in line with the NTP guidelines. Children <5 years old with a history of TB contact had a higher chance of being diagnosed according to the NTP guidelines.
This study indicates a low adherence of NTP guidelines for diagnosing childhood TB by private providers in Pakistan.
巴基斯坦国家结核病控制规划（NTP）与巴基斯坦儿科协会一起制定了儿童结核病（TB）辅助诊断的儿科评分表。本研究比较了巴基斯坦私立医疗机构提供者的诊断实践与 NTP 指南。
一项横断面研究，比较非 NTP 私立提供者诊断 <15 岁儿童结核病的情况与 NTP 的儿科评分表。使用广义线性模型确定非 NTP 私立提供者根据 NTP 指南诊断儿童结核病的依从性因相关因素而异。
共有 5193 名（研究期间在所选择地区发现的疑似儿童结核病病例的 79.7%）儿童被非 NTP 私立提供者诊断为结核病。强烈的结核病临床怀疑为 17.3%，胸部 X 线片提示结核病为 34.3%。非 NTP 私立提供者与 NTP 结核病诊断指南之间的 Kappa 评分为 0.152。只有 47.8%的病例符合 NTP 指南的诊断。有结核病接触史的 <5 岁儿童更有可能根据 NTP 指南进行诊断。
本研究表明，巴基斯坦私立提供者在诊断儿童结核病时，对 NTP 指南的遵循程度较低。
