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Diagnosis, treatment and management of pediatric tuberculosis in health emergencies and disasters

PI: Salvacion Gatchalian, University of Philippines, College of Medicine, Philippine General Hospital
NIH Partner: Kristy Murray, Baylor College of Medicine
Project Dates: February 2015 - April 2019

Project Overview:

PH 2-6 Philippines Q3 2015Background: The province of Bohol was recently struck by earthquake and swept by Typhoon Haiyan, creating destruction and interruption of health services. Included in the disruption were TB screening, prevention and DOTS programs. In addition to concerns over the disruption of services, extensive crowding in emergency shelters and camps potentially put children at higher risk for exposure to TB.

Study Rationale: Although there is very limited evidence to guide TB control strategies during displacement following natural disasters, interagency guidelines have been developed to address TB treatment in the acute and recovery periods following a complex emergency. The importance of reconstructing TB services during the post-conflict phase is well recognized and requires coordination and collaboration among key stakeholders. Experience has demonstrated that major impediments to successful reconstruction of TB services include mobile populations, destroyed infrastructure, and lack of coordination and/or interest in TB treatment, leading to poor case detection and sub-optimal TB control. However, all of these challenges are also opportunities to introduce interventions to improve TB control.

Proposed Design: (1) Cross-sectional cluster survey using rapid assessment methods to determine the prevalence of TB infection and disease in children under age 15, and (2) a descriptive study using social science mixed methods to assess barriers to pediatric TB control, prevention, and treatment post-disaster.

Geographic Area and Target Population: Bohol, Philippines. Children affected by health emergencies and disasters.

Anticipated Outcome: Assessment of prevalence and risk of TB infection and disease among children displaced by health emergencies and disasters. An understanding of how the disasters impacted TB treatment, prevention, and control.

Objectives: To assess prevalence of TB infection and disease in children under age 15 in Bohol and determine if risk for TB disease increased due to displacement associated with densely populated transitional housing, or increase in household members resulting from natural disasters affecting the island in 2013. Aim 1: Estimate prevalence of TB disease in children in the community and those currently residing or having a history of residing in disaster camps/shelters in Bohol using rapid assessment cross-sectional cluster survey methods. Aim 2: Assess correlation between validated risk factor assessment score and positive TB cases and compare actual prevalence of TB to baseline as well as differences in prevalence in displaced versus non-displaced children. Aim 3: Examine sensitivity and specificity of GeneXpert in sputum and stool as compared to direct smear. Aim 4: Document barriers to implementation of IPT and document additional barriers/disruption of services that occurred post-disaster.

Summary of Recent Activities:

From October to December 2015, not much activity was conducted as the study team was awaiting the final approval from the Ethics committee. Ethical approval was received by mid-November. Shortly after the study team started contacting potential site staff consisting of physicians (pedestrians, family physicians and new licensed graduates interested to work in research), nurses, and encoders. Drafting of the standard operating procedures began and once finalized will be used for training and will be disseminated to the field staff.

PEER Health Cycle 2 Recipients