title: Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?
abstract: BACKGROUND
  Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM).
  
  
  OBJECTIVE
  To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to TB treatment under the Revised National Tuberculosis Control Programme (RNTCP).
  
  
  METHODS
  A retrospective cohort study was conducted that included medical record reviews of SAM children registered for TB screening and RNTCP care during July-December 2012.
  
  
  RESULTS
  Among 440 SAM children screened, 39 (8.8%) were diagnosed with TB. Among these, 34 (87%) initiated TB treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilograms-the current weight requirement for receiving drugs under RNTCP.
  
  
  CONCLUSIONS
  ICF approaches are feasible at NRCs; however, screening for TB entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with TB were treated by the RNTCP. More effort is needed to link this vulnerable population to TB services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilograms.
authors.affiliation: WHO Country Office for India, New Delhi, India.
authors.forename: Rajeev R
authors.initials: RR
authors.lastname: Pathak
authors.affiliation: State Tuberculosis Training and Demonstration Centre, Patna, India.
authors.forename: Bal Krishna
authors.initials: BK
authors.lastname: Mishra
authors.affiliation: US Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, USA.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.affiliation: WHO Country Office for India, New Delhi, India.
authors.forename: Sreenivas A
authors.initials: SA
authors.lastname: Nair
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: Ajay M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: WHO Country Office for India, New Delhi, India.
authors.forename: Mohit P
authors.initials: MP
authors.lastname: Gandhi
authors.affiliation: WHO Country Office for India, New Delhi, India.
authors.forename: Shamim
authors.initials: S
authors.lastname: Mannan
authors.affiliation: US Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, USA.
authors.forename: Smita
authors.initials: S
authors.lastname: Ghosh
keywords: Children; India; Malnutrition; Screening; Tuberculosis