Bangladesh National Guidelines for the Management of TB in Children 2016

Directorate General Of Health Services under Ministry Of Health And Family Welfare Bangladesh has published the National Guidelines for the Management of TB in Children recently. 1st edition was published in 2012 and now the 2nd edition has been published in 2016. A lot of changes has been made in this new TB guideline. It is published by World Health Organisation (WHO). WHO has the policy to review guidelines every 3-5 years. Hence, NTP, Bangladesh has decided to publish the second edition of the guideline. Bangladesh is a hugely populated country and Tuberculosis is a major public threat. The Govt is working with WHO to reduce the mortality and morbidity. Bangladesh has an estimated population of 160 Million and children <15 years is 53.7 Million. Children’s are at great risk of TB. Keep this TB Guideline pdf in your mobile for quick referrence.

Editorial Board-

1. Dr. Shahid Md. Sadiqul Islam
2. Dr. Shakil Ahmed
3. Prof. Md. Ruhul Amin
4. Dr. Vikarunnessa Begum
5. Prof. ARM Luthful Kabir
6. Prof. Md. Abid Hossain Mollah
7. Prof. Mohammad Shahidullah

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Bangladesh National Guidelines for the Management of TB in Children 2016

How to Buy Hardcopy of TB Guideline?

It is available in Aziz Super market, Shahbag. Both color print and the balck-white print is available. If you want it by Courier service, that can be managed too.

Active Disease of TB

Only a small percentage of children who inhale the TB bacilli develop active disease. A child is said to have TB disease (active disease) if-

1. Infected with Mycobacterium tuberculosis, with
2. Clinical sign symptoms,
3. With or without laboratory or radiologic evidence suggestive of TB.

How to Diagnose a Case of TB?

According to the new guideline:

1. Careful history (including history of TB contact and symptoms suggestive of TB)
2. Clinical assessment (including serial weight monitoring)
3. Investigations

• Mantoux test
• Chest X-ray and other radiological evaluation
• Bacterial confirmation whenever possible
• Investigations relevant to suspected PTB/EPTB
• HIV testing

Symptom Criteria for Pulmonary TB:

1. Persistent,  non-remitting  cough  for  >2  weeks  not  responding  to  conventional  antibiotics (amoxicillin, co-trimoxazole or cephalosporins) and/or bronchodilators

and/or

2. Persistent documented fever (>38 o C/100.4 o F) for >2 weeks after common causes such as typhoid, malaria or pneumonia have been excluded

and/or

3. Documented  weight  loss  or  not  gaining  weight  during  the  past  3  months  (especially  if  not responding  to  de-worming  together  with  food  and/or  micronutrient  supplementation)  OR severe malnutrition

and/or

4. Fatigue, reduced playfulness, decreased activity.

Diagnostics tests have been elaborated here.

Clinical Criteria For Diagnosis Of Tb In Children

The presence of 3 or more of the following features suggests a diagnosis of TB:

1. The presence of 3 or more of the following features suggests a diagnosis of TB:
2. Symptom criteria suggestive of TB
3. A history of recent close contact (within the past 12 months)
4. Physical signs highly suggestive of TB
5. A positive Mantoux test
6. Chest X-ray suggestive of TB
7. Special laboratory test- CSF, Histopathology

Treatment Of TB In Children

Streptomycin is now on the list of 2nd line Anti-TB drugs. All children who have been diagnosed with TB disease must receive directly observed treatment (DOT) with the appropriate regimen and this must be recorded in the TB treatment register.

1st Line Drugs:

1. Isoniazid
2. Rifampicin
3. Pyrazinamide
4. Ethambutol

Doses of Fixed Doses combination has changed.

See the PDF for full texts. Thanks