1. OPTIMIZING THE QUALITY OF CARE FOR CHILDREN WITH TUBERCULOSIS Dr
OPTIMIZING THE QUALITY OF CARE FOR CHILDREN WITH TUBERCULOSIS Dr. lorraine Mugambi-Nyaboga KENYA PEDIATRIC ASSOCIATION SAROVA WHITESANDS, RESORT AND SPA, MOMBASA, KENYA 11TH APRIL 2019

2. Outline
Global overview
Overview of TB in Kenya
What is quality in the context of Childhood TB
The roadmap to Ending TB in children and adolescents
Conclusion

3. Global Overview

5. TB in Kenya

6. Kenya Findings: Kenya National Prevalence, 2016

7. Childhood TB

8. Kenya Case Notification

9. Case notification among the children

10. Optimizing Quality of Care in the context of childhood TB

12. Progress made 2014-2018 But Gaps Remain
No. <5 initiated on TPT increased from 734 in 2014 to 6,079 in 2017
Only 13% of the eligible household child contacts accessed IPT in 2017
WHO estmates 2/3 children with TB missed
Updated training materials, job aids and algorithms developed
Many frontline health care workers in all sectors do not have adequate knowledge and confidence to undertake prevention and diagnosis of childhood TB
Engagement of pediatricians from across 47 counties through the KPA conducted to provide leadership for childhood TB diagnosis and treatment in public and private hospitals
Diagnosis of childhood TB is still predominantly at the higher-level health facilities (level 4 to 6) with limited capacity at the peripheral health centers and dispensaries. Engagement of pediatricians in childhood TB not been fully realized in the private health sector
Childhood TB services fully decentralized across the 47 counties with capacity to conduct child contact management and provide child friendly TB treatment
Weak linkages and limited integration with maternal, child health still persist in many health facilities leading to missed opportunities for diagnosis.
Capacity for diagnosis and treatment of DR-TB among children is limited across the country
Focused national stewardship of childhood TB with a strengthened national technical working group, and a childhood TB focal person
Lack of functional broad- based technical working groups at the county level to steward childhood TB services.
Treatment success rate improved from 79 % to 85% partially attributed to the improved quality of care associated with the introduction of new child friendly pediatric formulations
Adoption of pediatric friendly DRTB formulations is yet to be realized

13. Optimizing Quality of Care in the context of childhood TB

14. BEST PRACTICES IN CHILD AND ADOLESCENT TUBERCULOSIS CARE

15. 1. TB Prevention among children
Three major categories of health interventions are available for TB prevention:
Treatment of LTBI
Infection prevention and control -prevention of transmission of M. tuberculosis (Administrative, Emvironmental and PPE)
BCG (bacille Calmette-Guérin) vaccine at birth

16. Treatment of Latent TB Infection
6H- INH for 6 months (daily)
Since March 2015
10mg/kg daily for 6 months
3HP (Rifapentin & Isoniazid)
weekly for 3 months
3RH (rifampicin and Isoniazid)
daily for 3 months
children and adolescents aged < 15 years in countries with a high TB incidence.

17. 2. Timely Diagnosis of TB in children
22,000 children fell ill with TB.
Only 6440 were diagnosed and treated
15,5560 went undiagnosed and untreated
In 2017
Upto 50% of children 5-14 years with TB were diagnosed
2/3 of children 0-4 years with TB were missed

19. Children; Pneumonia and Tuberculosis
A TB patient typically presents to a facility up to 5X before a diagnosis of TB is made. (Defining and assessing the maximum number of visits patients should make to a health facility to obtain a diagnosis of pulmonary tuberculosis. Harries AD1, Nyirenda TE, Godfrey-Faussett P, Salaniponi FM)
Tuberculosis is a major cause or comorbidity of childhood pneumonia in tuberculosis-endemic areas: a systematic review
(Tuberculosis as a cause or comorbidity of childhood pneumonia in tuberculosis-endemic areas: a systematic review. (Oliwa JN et al, Karumbi j, Marais B, Madhi S, Mgraham S)

20. Does ACF really work?

21. Does ACF really work. Increasing case detection in Kisumu county…
Does ACF really work? Increasing case detection in Kisumu county…. KEMRI CDC experience 19.3% vs 2.5% vs 1.8%

22. Diagnostic Yield of Xpert® MTB/RIF Assay and Mycobacterium Tuberculosis Culture on Respiratory and Non-respiratory Specimens among Kenyan Children , KEMRI CDC
* Cx or Xpert positive; among children with available specimens

24. 3. Treatment-Use the child friendly TB formulations

25. The Roadmap for Childhood TB: Toward Zero Deaths WHO, stop TB partnership IUATLD CDC USAID
Prioritize childhood TB at all levels.
Empower healthcare workers to Think TB through training and access to childhood TB screening tools.
Integrate TB screening into existing family, community, and health services.
For every adult TB case, look for exposed children through contact tracing.
Provide therapy to prevent TB for children at high-risk of developing disease.
Collect and report more accurate data about TB in children to enable improved approaches.
Invest in development of new tools, including child-friendly diagnostics and medicines.
8/14/2019

27. Conclusion
Ending TB in Kenya requires a collaborative multi sectoral approach
Child hood TB is underestimated and a sign of ongoing transmission
High index of suspicion required (prolonged weight loss, fever, cough-always be investigated, )
Treatment – like adult but use the current weight to calculate dosage-use the new child friendly formulations
Prevention more important in this age group
SAVE OUR CHILDREN
8/14/2019

28. A world of healthy families begins with Healthy Children Thank you!

29. Acknowledgements Ministry of Health NTDLP All county governments
USAID-TB ARC
WHO
Other implementing partners supporting TB/HIV activities
Facility staff who do the work