Coordinated programme sought for controlling child TB

Speakers at a roundtable discussion Wednesday stressed the need for a national coordinated programme aiming to control child tuberculosis (TB) involving all stakeholders including general physicians, paediatrics and caregivers.

They also said mass awareness programme is needed to control childhood TB.

"We have success story in TB control programme. To make this success one hundred per cent, we need to develop a coordinated approach involving practising physicians, paediatrics and care providers from the government and NGO sector, media and community," Director General of Health Services Dr Deen Muhammad Nurul Haque said.

He was speaking as the chief guest at the roundtable discussion styled 'Tuberculosis Control Programme: Childhood Tuberculosis'.

The Financial Express, Brac and National Tuberculosis Control Programme (NTP) jointly organised the discussion meeting at Brac Inn in city.

A large number of physicians, experts and officials from the government and non-government sectors were present at the meeting with FE Joint Editor Shamsul Huq Zahid in the chair.

FE Planning Editor Asjadul Kibria moderated the discussion while NTP Division Consultant of Dhaka Division Dr. Ahmed Parvez Zabeen presented keynote paper on the topic.

Dr. Haque said: "I find lack of coordination in the total process of TB control programme, specially child TB. Now we need to think how we can involve the practising paediatricians in the approach to child TB control."

Citing a number of cases of non-cooperation, he suggested a coordinated online programme for TB patients to list the cases and respond immediately so that each stakeholder knows the update.  

"Let us establish some kind of coordination; it could be through online."

Dr. Haque said, "We can develop a system. Wherever a paediatric identifies a case of child TB, he or she can put the data online and somebody should be there to collect the information online and respond accordingly."

He said a team or a cell can work in this connection to collect the information from all over the country and scan those so that it can promptly respond to the child TB cases.

"Only then we will be able to develop an excellent TB control programme. We will be able to stop unnecessary death of a child from TB," he said.

The Health DG said the Centre for Disease Control and Prevention (CDC) of Atlanta, US is going to help the country to develop a world class disease surveillance system.

"We find TB cases and then treat those taking data but we don't have any strong surveillance system. We are working with the CDC to develop a disease surveillance system."

He also said the CDC will help Bangladesh develop an outbreak response system whenever any unknown disease comes up.

Mr. Haque, a renowned eye specialist, said the US is helping Bangladesh establish bio-safety Level-Three laboratory for strengthening bio-security and bio-safety system.

Speaking as the special guest, Programme Manager of NTP Dr. Mozammel Haque said they are going to publish the second edition of the national guidelines for the management of tuberculosis in children.

"It is a great achievement that Bangladesh has first developed excellent guidelines for TB management in South Asia. Even many other countries are following us," he said adding that the second edition will be a more informative and effective one.

Dr. Haque said NTP will form an advisory group for addressing child TB.

He said NTP will seek help from the World Health Organisation (WHO) to strengthen the healthcare system to detect TB.

National Programme Consultant of NTP Dr. Mujibur Rahman recommended general physicians to take help from the TB expert doctors if any complex case arises.

Dr. Md. Akramul Islam, Director of tuberculosis and malaria control, water, sanitation and hygiene (WASH) and disaster, environment and climate change (DECC) of Brac, feared there might be an increase of TB, specially child TB in urban areas because of rapid urbanisation in the country.

Dr. Shakil Ahmed, former Assistant Professor of Shaheed Suhrawardy Medical College and Hospital said over 5,00,000 malnourished  children living in urban slums should be taken care of," he said.

Senior Programme Manager of Brac TB Control Programme Dr. Shaila Islam urged private practitioners to coordinate among themselves for controlling child TB.

Presenting the keynote paper, Dr. Ahmed Parvez Zabeen said the best way of preventing TB disease in children is to diagnose and successfully treat the adult TB, especially the infectious one.

"In fact, TB in children is the result of failure of adult infectious TB cases. So, in order to prevent child TB, we need an effective TB control programme," he said.

Head of the paediatric department of BIRDEM Professor Tahmina Begum said community health clinic assistants should be motivated so that they go to the people's homes to make them aware about BCG vaccine.

NSDP TB Coordinator Dr. Mohammad Hossain urged the concerned government authority to ensure BCG vaccine for children immediately after birth.

Programme Consultant of UPHCSDP Dr M Lutfor Rahman said, "Many hospitals do not admit patients with TB patients. The authorities should look into this," he said.

Advisor to GF&MDR TB Abdul Hamid Selim said, 'contact' of disease should be redefined in the new NTP guidelines so that more people can be brought under scanner.

ICDDRB epidemiologist Dr. K Zaman said there is still misconception that children are not infected with TB.

Head of Pediatric Department of Shaheed Suhrawardy Medical College and Hospital Dr. Syeda Afroza stressed the need for more effective ways to trace contact history of a TB patient.

Deputy Programme Manager of NTP Dr. Mirza Nizam Uddin said NTP has taken initiative to disseminate knowledge on child TB to the rural level.

Consultant Paediatrician and Research Coordinator of CWCH Dr. Khurshid Talukder said physicians should shun the view that child TB diagnosis is very difficult.

A child TB case can easily be diagnosed if s/he has persistent non-remitting cough, weight loss and is not playful.

Speaking as the chair, FE Joint Editor Shamsul Huq Zahid said there is mass awareness about the TB, specially child TB, but awareness is one thing and action is different.

"Patients will benefit from effective action at the ground level," he said.

He urged the concerned authority to take tools and knowledge to the rural areas for improved detection and treatment.

    bdsmile@gmail.com