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Title: Implementation of INH Chemoprophylaxis in children below 6 years of age as per RNTCP Paediatric guidelines in a tertiary hospital: a situational analysis

Article Number: EC2/2015/181

Authors: Roshni Chugh, Dr. Aarti Kinikar

Topic: Medicine


In a developing country like India, education and awareness about health problems among the masses is one of the most significant concerns. This lack of knowledge about various diseases that is prevalent throughout our country is having an adverse effect on the health status of our population. Tuberculosis (TB) is an example of one such disease. According to the WHO TB Report 2014, India accounts for 23% of the global with TB cases, where the deaths rose to 1.5 million deaths last year which included 140,000 children. However, surprisingly, childhood TB is given a low priority in most national health programs and is often neglected in this epidemic. The source of infection for most children is an infectious adult in close proximity.

 India has the Revised National Tuberculosis Control Program (RNTCP), aimed at tackling TB includes guidelines for Pediatric TB as well. Under this Program, INH Chemoprophylaxis at 10 mg/ kg/day is expected to be administered by health care professionals to asymptomatic children and those not suffering from TB; these children should be <6 years of age and in close contact with a sputum positive adult TB patient. However, despite this recommendation, we found that many of these children were not initiated on INH Prophylactic Treatment (IPT).

AIM: To assess the implementation of RNTCP guidelines regarding INH Chemoprophlyaxis for children below 6 years age in contact with sputum positive adult TB patients followed in clinical practice.

METHODOLOGY: This is a cross sectional observational study, to be conducted at TB OPD/ ward of a tertiary level teaching hospital. The study participants were diagnosed patients of TB who are sputum positive and are coming to the TB OPD/ admitted in the TB ward of a tertiary care referral teaching hospital (urban area).

The conduct of the study will be an interview using this pre-designed questionnaire, administered by a researcher in the TB OPD/ ward, which would lead to a statistical analysis of the percentage of patients who were informed, initiated,  and those still unaware of the IPT for their children who are below 6 years of age.

 RESULTS: Of 160 index TB adult sputum positive patients identified, 49 (30%) were eligible under the study as they had children less than 6 years of age.The profile of the children of these 49 patients was taken. Sixty six children of these 49 patients were eligible and should have received the IPT regimen.

Of the total number of patients who were interviewed, only 9 patients (18.4%) initiated their children on INH Chemoprophylaxis, this included 15 children out of eligible 66 children (22.7%) .The most prominent observation made was this low level of awareness regarding IPT implementation with only 2 children (13%) completing the entire course of therapy and 2 children (13%) having poor level of adherence completing less than 2 months of therapy, and the rest 11 children (74%) having very poor levels of adherence.


CONCLUSION: This study confirms the poor level of implementation of the RNTCP guidelines regarding the INH Chemoprophylaxis, to be given in children <6 years of age in contact with sputum positive TB patients.


    COMMENT - 1

  • Matin Ahmad Khan (Viewer) 18th Nov 2015 - 4:02 PM
    Various studies Isoniazid prophylaxis reduces the risk of developing tuberculosis by 59% among children aged 15 years or younger excluding children initiated during early infancy for primary prophylaxis. But in our country with exposure of TB at very early age put the children at additional risk of getting TB infection and treating with a single medicine INH as chemo-prophylaxis can be counter productive resulting into 'MDR -TB . So further studies are needed to assess effects on mortality and to determine prophylaxis effectiveness in very young children and and even among HIV-infected children in our set ups More studies like yours are required.

  • COMMENT - 2

  • Surya Narayanan Sethumadavan (Viewer) 19th Nov 2015 - 3:54 PM
    While the intention is indeed welcome, isn't over aggressive treatment of tuberculosis an open invitation to several problems like bone marrow suppression and blood disgraciases? How do we deal with side effects of TB treatment in children? And statistic generation in India especially in remote areas where childhood tuberculosis is prevalent is a big challenge. What are the other studies being done to generate statistics. Is the WHO report the only basis for decide the prevalence of tuberculosis in pediatric age group?

  • COMMENT - 3

  • C.D. Dayanand (Viewer) 25th Nov 2015 - 9:11 AM
    Dear author
    Excellent observation, kindly do it in larger scale and provide data to GOI
    my question is that, questionnaire prepared was present in their local language if yes ignore this question

    Prof Dr C.D.Dayanand

  • COMMENT - 4

  • Sandeep T (Viewer) 25th Nov 2015 - 10:31 AM
    Were there any adverse effects in the children due to the drug?

  • COMMENT - 5

  • Amitabha Ray (Viewer) 25th Nov 2015 - 10:39 PM
    This paper would have been more complete if the authors had provided some comparative data from neighboring South Asian countries. Nevertheless, this is a valuable contribution to the existing literature, and hopefully future researchers will be able to utilize the data in a comparative context.