Training doctors to diagnose paediatric TB to start soon

In a few months from now, children in India with paediatric TB will stand a better chance of being diagnosed early and treated without much delay.

This will become possible with the Indian Academy of Paediatrics (IAP) partnering with the Child TB Division of the Ministry of Health and Family Welfare and RNTCP to train doctors. IAP will target paediatricians from the private sector and medical officers at public health centres (PHCs) and family practitioners.

“The Ministry of Health Child TB Division is very keen on joining hands with IAP for training the doctors and disseminating information on the updated guidelines [published last year] for diagnosis and management of paediatric TB,” said Dr. Vijay N. Yewale, National President of IAP, Mumbai. Dr. Yewale’s note on this has been published in the latest issue of Indian Pediatrics.

According to the WHO, 10-20 per cent of all TB cases occur in children in high-burden countries like India. Unfortunately, only seven per cent (84,000 cases) of childhood TB cases were diagnosed in 2011, notes a March 2013 paper in the Indian Pediatrics journal.

Currently, besides the near-total neglect of childhood TB and the difficulty in diagnosing TB in children aged under five years, doctors are not fully trained to correctly suspect and diagnose paediatric TB on time, and manage the disease. They are also largely unaware of the different techniques available to extract sputum samples from children aged under five years.

Children under five years of age have difficulty in producing sputum, the most basic sample required for bacteriological confirmation of the disease. Older children have adult-like TB and hence diagnosing it is not fraught with problems.

The Academy plans to train paediatricians from the private sector to diagnose and manage paediatric TB cases, while medical officers at PHCs and family practitioners will be trained on when to suspect childhood TB cases and refer the suspected cases to district hospitals or RNTCP programme officers for further investigation. Since, medical officers are the first point of contact for those approaching the PHCs, training them would greatly help in diagnosing more children with TB disease.

The initial programme entails training around 50 paediatricians from across India for two days. These doctors would, in turn, train other paediatricians for a day. “We are aiming to start the traning programme of 50 paediatricians by May end,” said Dr. Yewale. “By June end–beginning July they [the trained paediatricians] will begin training other paediatricians for a day.”

The plan is to conduct about 30 one-day workshops [to train paediatricians] during the first year. “The training will be undertaken every year for years to come,” he said.

“The training for paediatricians will be a little more extensive,” Dr. Yewale said. “But for medical officers, it will be [restricted to] on when to suspect TB and timely referral.”

With a membership of around 23,000 paediatricians and 320 branches across the country, IAP is optimistic of reaching out and training a large section of the private doctors. “IAP is more organised and their network goes down to the district levels… they know how to do it,” said Dr. Soumya Swaminathan, Director of the Chennai-based National Institute for Research in Tuberculosis (NIRT). “Earlier, they had done it for paediatric HIV.”

“Once we involve the medical officers [at PHCs], the next step will be to target health workers and community workers,” Dr. Yewale said. “There will be some improvement in RNTCP performance in the case of contact tracing.”

The WHO has recommended and RNTCP has also approved contact tracing of children below five years in households where an adult has been recently diagnosed with active pulmonary TB disease. But in reality, awareness about contact screening of such children and its implementation is “sub-optimal” in India.

The current plan to train paediatricians and medical officers is likely to result in more children with TB being correctly diagnosed on time and managed.

Published in the Hindu on April 10, 2014