Interdisciplinary Perspectives on Infectious Diseases

Research Article

Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai

Table 1

Indicators and items developed for assessing compliance of paediatricians with International Standards of Tuberculosis Care (ISTC) 2009.


Standard	Item used to elicit information regarding indicator	Indicator to assess compliance with ISTC

1	List symptoms that would lead to suspicion of TB	Cough listed as one of the symptoms that would lead to suspicion of TB (yes/no)

2	List investigations prescribed for diagnosis of pulmonary TB	Advising sputum smear/culture for diagnosis of pulmonary TB (yes/no)

4	Investigation advised when chest X-ray is positive (sputum test/TST/CBC-ESR/other investigations/start treatment without any investigations)	Advising sputum smear/culture among those with positive chest X-ray findings (yes/no)

6	Action taken when child is not able to produce sputum (induce sputum by GL or BAL/TST/CBC-ESR/other investigations/start treatment without any investigations)	Advising GL or BAL when child is not able to produce sputum (yes/no)
6	List investigations advised for diagnosis of pulmonary TB	Chest X-ray and/or TST advised along with sputum smear/culture (yes/no)

8	Write first regimen prescribed by you for a case of childhood TB	Is the regimen prescribed for cases of pulmonary TB 2HRZE + 4HR? (Yes/no)

10	When is the treatment stopped?	Is the response monitored clinically at end of treatment? (yes/no)

11	List reasons for suspecting drug-resistance at initiation of treatment	Suspecting drug-resistance at initiation of treatment, (a) if patient has history of contact with a case of MDR (yes/no); (b) if patient has received treatment for TB in past (yes/no)
11	Drug-resistance is suspected when sputum positive status persists at (how many) months of antitubercular treatment	Whether drug sensitivity test for rifampicin is timely (in case of positive sputum smear after two or three months of treatment)? (Yes/no)

12	Write regimen prescribed for a case diagnosed with MDR-TB	Regimen prescribed for MDR-TB includes four new drugs with one being injectable and one fluoroquinolone (yes/no)

Multiple response; all items and indicators were with respect to pulmonary TB in children; TST: tuberculin sensitivity test, CBC: complete blood count, ESR: erythrocyte sedimentation rate, GL: gastric lavage, BAL: bronchoalveolar lavage, and MDR: multidrug-resistance.