The Bangladesh National Tuberculosis Control Program (NTP), in partnership with USAID through the TB CARE II project, recently published a set of guidelines meant to assist in the diagnosis and management of TB in children. The guidelines come in response to the World Health Organization (WHO)’s Stop Tuberculosis (TB) Strategy. The Strategy, which ultimately seeks to create a TB-Free world, promotes equal access to care for all people in an effort to reduce the human suffering and socioeconomic burden associated with TB. This document is meant to work in conjunction with existing WHO guidelines to assist in filling a significant gap in knowledge relating to the diagnosis and management of pediatric TB.
While the diagnosis of adults with TB is a rather straightforward process in which clinicians examine sputum samples for acid-fast bacilli, pediatric cases are much more difficult. Children often do not present TB symptoms in the same way that adults do. Furthermore, the disease is paucibacillary (meaning there is not a lot of bacteria in the mucus) which makes it more difficult to diagnose microbiologically. Test results can also be skewed depending on whether the child is extremely malnourished or HIV positive. As a result, diagnosis relies heavily on clinical examinations and historical investigations.
Additionally, there seems to be a gap in the number of pediatric TB cases that are reported each year by NTP with that of the actual disease burden of the community. Without improving the detection and diagnoses process of TB in children, it will be impossible to properly manage the disease.
The guidelines address key risk factors, standard case definitions, diagnosis, treatment, and prevention for pediatric TB in an effort to better educate health care managers and providers involved in every level of pediatric TB care in Bangladesh – both within NTP itself, as well as in the public and private sector.