title: Intervention to increase detection of childhood tuberculosis in Bangladesh.
abstract: BACKGROUND
  Despite a well-functioning adult tuberculosis (TB) control programme, children with TB remain grossly under-detected in Bangladesh. It is conservatively estimated that annually around 21,000 children with TB go undetected, due to an almost exclusive focus on sputum smear-positive TB and the absence of training or guidelines in paediatric TB.
  
  
  OBJECTIVE
  To double child TB detection by increasing general awareness and training of health care workers at microscopy centres supported by the Damien Foundation (DF) Bangladesh.
  
  
  METHODS
  A cluster-randomised trial was carried out with provision of child TB guidelines, training and logistics support to staff of 18 microscopy centres, while 18 non-adjacent microscopy centres continued their usual practice and served as controls. Paediatric data on TB suspect referral and case detection were collected at baseline and during the intervention at both control and intervention sites.
  
  
  RESULTS
  Child TB case detection increased in both intervention and control microscopy centres, but the increase was three times the baseline in the intervention centres (from 3.8% to 12%) in comparison to less than double the baseline in the control centres (from 4.3% to 7%, P = 0.001).
  
  
  CONCLUSIONS
  Simple guidelines and training on child TB case detection, together with basic logistics support, can be integrated into the existing National TB Control Programme and improve service delivery to children in TB-endemic areas.
authors.affiliation: Centre for Woman and Child Health, Savar, Dhaka, Bangladesh. khurshidtalukder@yahoo.co.uk
authors.forename: K
authors.initials: K
authors.lastname: Talukder
authors.forename: M A H
authors.initials: MA
authors.lastname: Salim
authors.forename: I
authors.initials: I
authors.lastname: Jerin
authors.forename: F
authors.initials: F
authors.lastname: Sharmin
authors.forename: M Q-K
authors.initials: MQ
authors.lastname: Talukder
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.forename: P
authors.initials: P
authors.lastname: Nandi
authors.forename: E
authors.initials: E
authors.lastname: Cooreman
authors.forename: M A
authors.initials: MA
authors.lastname: Rahman
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D001364:Awareness; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D016000:Cluster Analysis; D003150:Community Health Workers / Q000193:education; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015397:Program Evaluation; D012017:Referral and Consultation; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology