Malnutrition, specially under-nutrition has been strongly linked with tuberculosis among children. However, there is scarcity of literature and guidelines in this area. I am trying to develop screening and referral guidelines for childhood tuberculosis among malnourished children which can be used by different cadres of health workers in Nepal.
some general points to consider:
1. all children under five who are contacts of a TB patient should be actively screened (malnourished or not).
2. all non responders to SAM management ( i am not sure what nepal is doing on this front) defined as per SAM protocols should be screened for TB
3. it goes without saying that any malnourished child that suggests TB from history or examination must immediately be screened / referred.
4. any child with growth faltering over two readings (which would be two months in a community setting) despite corrective feeding action and medical treatment for the usual childhood illnesses needs to be referred as well.
pls let me know if you find any specific protocols in your search.
Thank you Vandana for these important points. Are these points mentioned in the National Tuberculosis Control program guideline in India? How does the referral system work there? Will let you know if I come across any specific protocol.
point one is there in the guidelines and strategy but not followed anywhere.
the guidelines also say that malnourished children will be screened twice a year but i have not seen any evidence of it anywhere.
referral systems, drugs and diagnostics are a huge problem.
the strategy document 2012-1017 acknowledges that paediatric TB is 'a challenge'
you can also look at the WHO guidance for national TB programmes for paediatric populations.
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