Background: Private providers provide a large portion of health care in Pakistan, including tuberculosis (TB). All TB patients are supposed to be reported to the National Tuberculosis Program (NTP), which provides drugs free of charge in addition to monitoring, supervision and support. It is difficult to confirm the diagnosis of TB in children. We aimed to assess the private health care provider investigation practices and management of childhood TB.
Methods: This cross sectional study was based on a national survey that measured under-reporting of children with TB in 12 selected districts in Pakistan from Apr-Jun, 2016. We explored the practices of private health care providers involved in the diagnosis of TB in children under 15 years for investigating and managing children suspected having TB, like general practitioners, pediatricians, pulmonologists and chest specialists.
Results: Among 6519 presumptive child TB cases, a total of 5193(79.7%) children under the age of 15 years were diagnosed as TB by private health care providers during second quarter, 2016. Out of all diagnosed TB cases, only 187(3.6%) were notified to NTP. The majority of presumptive child TB cases reported cough, fever, and failure to thrive; few had TB contacts with pulmonary TB patients. For further diagnostic tests, private providers relied on chest X-ray in 41.7% of 0-4 years and 48.2% of 5-14 years. Utilization of Tuberculin skin test and Gene-Xpert MTB/RIF testing was very low. Bacteriological confirmation was present in 9.6%, and clinical assessment was the only basis for diagnosis in 39.3%. Of children with presumptive TB, 3121(47.9%) cases were referred for diagnosis and 2443(37.5%) were referred after diagnosis for treatment; among all the referred, 3812(68.5%) were sent for investigations to District TB Centre(NTP).
Conclusion: This study showed that many private providers referred children suspected having TB to laboratories for further diagnosis, but cases identified in investigations were often not notified to the NTP. This problem needs to be resolved by strengthening the referral linkages between private health providers, NTP laboratories and treatment centres through capacity building and training of their staff.