title: Childhood tuberculosis deskguide and monitoring: an intervention to improve case management in Pakistan.
abstract: BACKGROUND
  Childhood tuberculosis (TB) has been a neglected area in national TB control programme (NTCP) in high burden countries. The NTP Pakistan adapted the global approaches by developing and piloting its policy guideline on childhood TB in ten districts of the country. We developed an intervention package including a deskguide and a monitoring tool and tested with the ongoing childhood TB care in a district. The objective of our study was to measure effectiveness of intervention package with deskguide and monitoring tool by comparing TB case finding and treatment outcomes among districts in 2008, and performance assessment in intervention district.
  
  
  METHODS
  An intervention study with cohort design within a routine TB control programme comparing case findings and treatment outcomes before and after the intervention, and in districts with and without intervention. We enrolled all children below 15 years registered at all nine public sector hospitals in three districts of Pakistan. The data was collected from hospital TB records.
  
  
  RESULTS
  In eight months during 2007 there were 164 childhood TB cases notified, and after intervention in 2008 a total of 194 cases were notified. In intervention district case finding doubled (110% increase) and correct treatment practice significantly increased in eight months. Successful outcomes were significantly higher in intervention district (37,100%) compared to control district A (18, 18%, p < 0.05) and control district B (41, 72%, p < 0.05).
  
  
  CONCLUSIONS
  Childhood TB deskguide and structured monitoring was associated with improved case management and it augmented NTP policy. More development and implementation in all health services of the district are indicated.
authors.affiliation: Association for Social Development, Islamabad, Pakistan. safdar.nauman@gmail.com
authors.forename: Nauman
authors.initials: N
authors.lastname: Safdar
authors.forename: Sven Gudmund
authors.initials: SG
authors.lastname: Hinderaker
authors.forename: Noor Ahmed
authors.initials: NA
authors.lastname: Baloch
authors.forename: Donald A
authors.initials: DA
authors.lastname: Enarson
authors.forename: Muhammad Amir
authors.initials: MA
authors.lastname: Khan
authors.forename: Odd
authors.initials: O
authors.lastname: Morkve
mesh_terms: D000293:Adolescent; D019090:Case Management / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D023801:Directly Observed Therapy; D005069:Evaluation Studies as Topic; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D011785:Quality Assurance, Health Care / Q000379:methods*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology