Ramirez Daniel, Brumwell Amanda, Rahman Md Mahfuzur, Hossain Farzana, Kulkarni Suchitra, Malik Amyn A, Campbell Jeffrey I, van de Water Brittney J, Kamul Md Kamruzzaman, Rahman Md Toufiq, Hussain Hamidah, Creswell Jacob, Roy Tapash, Brooks Meredith B
Boston University School of Public Health, Boston, Massachusetts, USA.
University of Washington, Seattle, Washington, USA.
J Glob Health. 2025 Jan 24;15:04024. doi: 10.7189/jogh.15.04024.
Programmatic interventions to increase the detection of children with tuberculosis (TB) are rarely evaluated to understand age- and sex-specific completion rates. We applied modified TB screening and treatment cascade frameworks to assess indicators of effective implementation by age and sex of a TB screening program for children (zero to 14 years) in Bangladesh.
We implemented an intensified screening program for paediatric TB detection in 119 health care facilities (2018-21). We followed systematic verbal screening by referral for full evaluation for children who reported symptoms or contact history with a patient with TB. Further, we linked children to treatment if diagnosed and followed for outcomes. We calculated the percentage of children, by age and sex, progressing through each step of the care cascade and compared the frequency of step completion by sex using χ tests.
In total, we screened 552 182 males and 461 419 females for TB. 2.8% of males and 2.6% of females screened positive (P < 0.001). 74.2% of males and 73.9% of females underwent appropriate evaluation (P = 0.560). 10.3% of males and 11.5% of females were diagnosed with TB (P = 0.008). 100% of children initiated treatment, and 97.6% of males and 97.1% of females achieved a successful treatment outcome (P = 0.428). The percent of children screening positive on verbal screen, who were clinically evaluated for TB, and who were diagnosed with TB generally increased with age, with some variability throughout (ranges: 1.2-9.1%, 59.8-88.5%, 6.5-21.9%, respectively).
The largest gap observed for both sexes and among all ages was children who were not appropriately evaluated for TB despite screening positive. In our research, we highlight the value of identifying gaps in paediatric TB care to inform innovative, age- and sex-tailored interventions to improve future care in children.
旨在提高儿童结核病（TB）检出率的规划性干预措施很少得到评估，以了解特定年龄和性别的完成率。我们应用改良的结核病筛查和治疗级联框架，按年龄和性别评估孟加拉国一项针对儿童（0至14岁）的结核病筛查项目有效实施的指标。
我们在119个医疗机构实施了一项强化的儿童结核病检测筛查项目（2018 - 2021年）。对于报告有症状或有结核病患者接触史的儿童，我们通过转诊进行系统的口头筛查以进行全面评估。此外，如果确诊，我们将儿童与治疗联系起来并跟踪治疗结果。我们按年龄和性别计算了在护理级联的每个步骤中进展的儿童百分比，并使用χ检验比较了按性别完成步骤的频率。
我们总共对552182名男性和461419名女性进行了结核病筛查。2.8%的男性和2.6%的女性筛查呈阳性（P < 0.001）。74.2%的男性和73.9%的女性接受了适当的评估（P = 0.560）。10.3%的男性和11.5%的女性被诊断为结核病（P = 0.008）。100%的儿童开始接受治疗，97.6%的男性和97.1%的女性治疗成功（P = 0.428）。在口头筛查中呈阳性、接受结核病临床评估以及被诊断为结核病的儿童百分比总体上随年龄增加，且在整个过程中存在一些差异（范围分别为：1.2 - 9.1%、59.8 - 88.5%、6.5 - 21.9%）。
在所有年龄组的两性中观察到的最大差距是那些尽管筛查呈阳性但未接受结核病适当评估的儿童。在我们的研究中，我们强调了识别儿童结核病护理差距的价值，以便为创新的、针对年龄和性别的干预措施提供信息，从而改善未来儿童的护理。
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