Alan Talens MD, MPH

World Renew CORE Group Community

Child Health Working Group

It's Not Complicated

Community Level

• Case finding • Treatment support • Advocacy ,• Patient /family support ,• Coalition building , • Training and supervision

Roadmap for Childhood TB: towards zero deaths

AIM OF GUIDE The Framework for Integrating Childhood TB

Into Community –Based Child Health Care

• To emphasize the importance of Childhood TB

• To stimulate discussion

• To move towards early integration of childhood TB into other maternal and child care activities

Areas for intervention in existing algorithmsAsk for TB contact in children with • HIV• cough >21 days • fever >7days• severe malnutrition‘Flag’ child as TB suspect

Identification of TB suspects for referral: TB contact• HIV• ARI• Malnutrition• Signs/symptoms of TB• Signs of EPTB

Follow-up: Child with TB contact/HIV who does not improve after treatment of ARI, malaria and/or who does not gain weight after feeding supplements should be referred as TB suspect

Ensure BCG was given

Ask for TB contact in child with ARI, malnutrition, TB signs/symptoms

TB is hidden in here: cough > 21 days = danger sign

Existing Community -Based Health Care Frameworks

• IMCI ( Integrated Management of Childhood Illness

• Community- IMCI

• CCM (Community Case Management)

IMCIIntegrated Management of Childhood Illness

Component of IMCI• Improving case management skills of

health-care staff• Improving overall health systems• Improving family and community health

practices

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=XazI1wd5SPTb9M&tbnid=PwoypoEBhL8JEM:&ved=0CAUQjRw&url=http://www.coregroup.org/our-technical-work/initiatives/ccm&ei=Za1KUpr8I4_a8ASg7IHgCA&psig=AFQjCNGbVaORF7TX9lVo00hbHeHPU9vcdA&ust=1380712161873694

Underlying principles in Community Based Health Care Integration

• Existing referral mechanism to next level of care (TB services) and support mechanisms for CHWs need to be in place.

• Start with simple, basic interventions.• Advanced interventions depending on

workload and skills of CHW.• Any question asked has to result in clear

action taken.

Steps to Take in Developing Integrated Community –based Health Care models for

Childhood TBChildhood TB

1. Advocacy for country adaptation of guidelines and training materials- for IMCI, C-IMCI and CCM and other programs for CHW to include Childhood TB as serious illness.

2. Improve quality of care of childhood TB at first-level public health facilities.

3. Improve quality of care /or recognition of childhood TB of private sector (traditional healers, private doctors ,drug distributors)

Steps to Take in Developing Integrated Community –based Health Care models for

Childhood TBChildhood TB

4. Improve partnership between health facilities or services and the communities they serve.

5. Increase appropriate, accessible care of and information on childhood TB from the Community-based providers.

6. Integrate promotion of key family practices critical for childhood TB together with child health (Immunization, breastfeeding, HIV and Infection control)

Conclusion

Childhood TB is often an undiagnosed illness contributing to significant global child

morbidity and mortality.

Integration of Pediatric TB in all levels, most especially at the community health level is a

must towards zero TB deaths in children

Thank you