Characteristics and programme-defined treatment outcomes among childhood tuberculosis (TB) patients under the national TB programme in Delhi.
BACKGROUND
Childhood tuberculosis (TB) patients under India's Revised National TB Control Programme (RNTCP) are managed using diagnostic algorithms and directly observed treatment with intermittent thrice-weekly short-course treatment regimens for 6-8 months. The assignment into pre-treatment weight bands leads to drug doses (milligram per kilogram) that are lower than current World Health Organization (WHO) guidelines for some patients.


OBJECTIVE
The main aim of our study was to describe the baseline characteristics and treatment outcomes reported under RNTCP for registered childhood (age <15 years) TB patients in Delhi. Additionally, we compared the reported programmatic treatment completion rates between children treated as per WHO recommended anti-TB drug doses with those children treated with anti-TB drug doses below that recommended in WHO guidelines.


METHODS
For this cross-sectional retrospective study, we reviewed programme records of all 1089 TB patients aged <15 years registered for TB treatment from January to June, 2008 in 6 randomly selected districts of Delhi. WHO disease classification and treatment outcome definitions are used by RNTCP, and these were extracted as reported in programme records.


CONCLUSIONS
Among 1074 patients with records available, 651 (61%) were females, 122 (11%) were <5 years of age, 1000 (93%) were new cases, and 680 (63%) had extra-pulmonary TB (EP-TB)--most commonly peripheral lymph node disease [310 (46%)]. Among 394 pulmonary TB (PTB) cases, 165 (42%) were sputum smear-positive. The overall reported treatment completion rate was 95%. Similar reported treatment completion rates were found in all subgroups assessed, including those patients whose drug dosages were lower than that currently recommended by WHO. Further studies are needed to assess the reasons for the low proportion of under-5 years of age TB case notifications, address challenges in reaching all childhood TB patients by RNTCP, the accuracy of diagnosis, and the clinical validity of reported programme defined treatment completion.
Satyanarayana
Srinath
S
Centre for Operational Research, International Union against Tuberculosis and Lung Diseases (The Union), Paris, France. ssrinath@theunion.org
Shivashankar
Roopa
R
Vashist
Ram Pal
RP
Chauhan
Lakhbir Singh
LS
Chadha
Sarabjit Singh
SS
Dewan
Puneet Kumar
PK
Wares
Fraser
F
Sahu
Suvanand
S
Singh
Varinder
V
Wilson
Nevin Charles
NC
Harries
Anthony David
AD
D000293:Adolescent; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D023801:Directly Observed Therapy; D017408:Guidelines as Topic; D006801:Humans; D007194:India / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D014944:World Health Organization
D000995:Antitubercular Agents