Diagnosis of childhood tuberculosis in Pakistan: Are national guidelines used by private healthcare providers?

• Published in: International journal of infectious diseases Vol. 107; pp. 291 - 297
• Main Authors: Yaqoob, Aashifa, Hinderaker, Sven Gudmund, Fatima, Razia, Shewade, Hemant D., Nisar, Nadia, Wali, Ahmed
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.06.2021; Elsevier
• Subjects: Children; Diagnosis; Guidelines; Pakistan; PPA scoring chart; Private providers; Tuberculosis; Tuberculosis; Pakistan; PPA scoring chart; Private providers; Children; Diagnosis; Guidelines
• DOI: 10.1016/j.ijid.2021.04.055
• ISSN: 1201-9712; 1878-3511

•Evaluation of childhood tuberculosis (TB) diagnosis by private healthcare providers.•Highlighted low utilization of the national guidelines for childhood TB diagnosis.•Less than 50% of private healthcare providers followed the guidelines.•Better training and expansion of public-private partnerships could improve take-up. 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.