Improving the care and diagnostic strategies of Tuberculosis in children in Botswana

The COE continues to upgrade the services for tuberculosis care for children in Botswana. Major components of our plan include improved diagnostic capacity, health worker education, mentorship, enhancing our collaborative partnerships, and patient education.

Baylor COE is collaborating with the Botswana National TB Programme (BNTP) and the Government of Botswana (GoB) to increase ready access to high-quality paediatric tuberculosis care and to train health care workers in the care of TB/HIV infected children according to the National guidelines.

Since the beginning of the Baylor's TB-related training activities, 11 Sputum Induction Training Workshops have been conducted. So far we have trained a total of 188 health care workers in sputum induction countrywide, comprising of the following:

Nurses: 85
Doctors: 20
Auxiliaries: 30
Physios: 11
IHS Lecturers: 5
Aux Lecturer: 1
Nursing Students: 32
Other: 4

Diverse attendance was selected to ensure that the practice is widely disseminated. Out of these 188, about 14 of them have begun conducting training themselves and a majority of these trained personnel do sputum inductions in their respective hospitals as part of their routine work. 140 (74%) participants have done at least 1 sputum induction, and 50 (26%) participants have done at least 5 sputum inductions.

The Baylor COE has successfully produced Paediatric TB/HIV IEC (Information, education and communication) materials with the approval of the BNTP to include: 15, 000 copies of pamphlets and 10,000 copies of posters written in both Setswana and English, which are currently being distributed free of charge to all health centers countrywide.

It is our hope that as we scale-up the routine use of sputum induction in children as a diagnostic modality for TB in children countrywide we will now be able to gather Botswana specific data about the actual prevalence of TB in children and other relevant parameters to inform the crafting of our National Paediatric TB diagnostic algorithm.

In addition to the didactic trainings above, the Botswana-Baylor program continues to provide mentorship-type training and clinical support to medical practitioners in rural areas and the ARV sites throughout Botswana, with a focus on pediatric TB. In the year 2009, pediatricians from the program, in collaboration with colleagues at Princess Marina Hospital and Nyangabgwe Referral Hospital, increased outreach to various district hospital ARV sites around Botswana. By September 2009, 23 outreach sites were receiving regular visits, more than triple the number a year prior. As documented above, both the didactic sessions and case-based mentorship offered during these visits incorporate a strong TB/HIV component.

Given the rate at which the Paediatric TB Project is expanding, we look forward to sharing our successes and findings with our colleagues and, when appropriate, the international community.

This programme has been made possible by the generous support of CDC/ BOTUSA.