To Determine the Outcome of Standardized Treatment of Multidrug-Resistant TB Among Pediatric Age Group at Drug-Resistance Tuberculosis Centre (DR-TB CENTRE) In Patiala, India

Abstract

PURPOSE: Tuberculosis has been a scourge of the human kind from time immemorial. It is a major health problem in India. The emergence of multi-drug resistant TB (MDR-TB) has become a significant public health issue and an obstacle to effective TB control. In 1997, Govt. of India has launched Revised National Tuberculosis Control Programme (RNTCP) and by 2006, whole nation was covered under it. To tackle the burden of MDR-TB, govt. has initiated Programmatic Management of Drug Resistant TB (PMDT), which referes to programme based diagnosis, management and treatment of MDR-TB. MDR-TB has become a serious health issue among paediatric population as well. We conducted a retrospective/ prospective study to evaluate the outcome of treatment of MDR-TB, among paediatric population in order to take further steps to improve and strengthen the programme. METHOD(S): A retrospective/prospective study was conducted at Dept. Of Pulmonary Medicine, GMC, Patiala. 39 paediatric cases admitted for MDR-TB, at DR-TB centre from 1st Jan 2012 to 31st Dec 2013 were included in this study and were followed up till treatment completion. The recommended baseline laboratory investigations were carried out in all patients. Follow up sputum smear and culture for AFB as per recommendations of the programme were carried out and records maintained. RESULT(S): Out of 39 smear positive children under study, at the end of 3 months, there were 10 smear positive and 12 culture positive cases. A total of 4 deaths were reported during this period. Out of the remaining 35 cases, there were 7 smear positive and 9 culture positive cases at the end of 6 months. 2 more deaths were reported during this period. At the end of 9 months there were 2 smear positive cases and 6 culture positive cases. 2 more deaths were reported during this period. At the end of treatment, 18 cases were declared cured, 6 cases reported treatment completed. A total of 10 deaths were reported, 2 cases defaulted and 2 cases shifted to Cat V treatment. One patient was transferred out and there was no failure reported. CONCLUSION(S): To conclude, 62% of cases have successfully completed treatment (46.5% cured, 15.5% treatment completed). A total of 25.5% deaths were reported during the treatment period. The death rate is on the higher side which may be due to late diagnosis and lack of proper nutritive and supportive care during the treatment period. The negligible default rate (5%) and 0% failure shows the effectiveness of the programme among the paediatric age group. 5% of cases were shifted to Cat V treatment.