Training For TB in Children

The week-long training for TB in children ended last Friday with a role-playing activity and workshop on planning for our activities related to TB in children. It was a refreshing experience, having re-learned my Tuberculosis lessons and having learned new updates on how to manage TB, including even new updates on IMCI (Integrated Management of Childhood Illnesses). IMCI is the standard guideline for managing common illnesses in children such as fever and diarrhea. Student nurses learn IMCI in school. What is funny is, medical students are not taught how to follow IMCI. IMCI is WHO recommended guidelines and while we doctors "know more" than "mere" nurses and midwives, that does not exempt us from following guidelines, especially evidence-based recommendations by the world's leading authority in health, the WHO.

It is a surprise really for us doctors, especially when the new IMCI guidelines recommended that for uncomplicated pneumonia in children, we can use Amoxicillin with a 25 mg/kg/dose regimen, 2 x a day for only 3 days. The common practice is to give Amoxicillin 3x a day, 30-50 mg/kg/day for 7 days. But according to the IMCI regional coordinator, a Pediatrician herself, this is the new guidelines.

If this is the case, then it is really advantageous for our municipality and our poor patients. Not only does this make medicines cheaper, it makes compliance better and therefore treats pneumonia accordingly.




The TB in children guideline is even filled with new updates. For example, Isoniazid is used to be given 10mg/kg/day. According to the new guidelines, Isoniazid can be given at 5 mg/kg/day. And now, Isoniazid Preventive Therapy is implemented but only for children ages 0-4 years old, TST positive and asymptomatic.

Managing TB in children is more complicated than managing TB in adults. Diagnosing or identifying children with Pulmonary TB alone is far more complicated. Since most children cannot expectorate, you cannot simply base your diagnosis on a positive DSSM (Direct Sputum Smear Microscopy). There are now ODT's (Other Diagnostic Tests) such as Chest X-rays and Tuberculin Skin Testing. Now, TST will be conducted for free. And this is really a big help for the indigents patients.

I do hope we can fully implement our TB program in our municipality and increase our case detection rate, and thereby eliminated TB in our list of morbidities and mortalities.