07 Ffy Tb Anak Dan Dots

download 07 Ffy Tb Anak Dan Dots

of 32

  • date post

    15-Apr-2017
  • Category

    Documents

  • view

    219
  • download

    1

Embed Size (px)

Transcript of 07 Ffy Tb Anak Dan Dots

  • Tuberkulosis Anak, DOTS, ISTC

    Finny Fitry Yani

    Courtesy :

    UKK Respirologi Anak IDAI

  • World problems of Tuberculosis (TB)

    Global problem

    Neglected Childhood TB

    Low Case Detection Rate

    Lack of holistic approach of TB management

    Non-standardized management

  • Global burden of tuberculosis (TB)

    1/3 of the population of the world have been infected Prevalence: 17.22 million (1990s ) 11.1 million (2008 ) New cases/year: 9.3 million (2007) 9.4 million (2008)

  • TUBERCULOSIS PROGRAMS

    GOAL:

    to break the chain of the transmission for eliminating the disease from society.

    Strategies:

    1)case finding and treatment of active disease

    2)treatment of LTBI

    3)vaccination with BCG

  • National TB Programs (NTPs)= P2 TB Kemenkes

    Focus on adult cases

    Pediatric TB

  • DOTS (Directly Observe Treatment Short-course)

    A global strategy to combat world TB problems

    Developed by WHO and IUATLD

    Introduced in early 1990, implemented in Indonesia since 1994s

    DOTS coverage in 2006: 98%

  • Komitmen Politis dan dukungan

    semua pihak

    1

    WHO 1991

    5 KOMPONEN DOTS

    2

    Diagnosis

    mikroskopik

    ANAK??

    3

    Pengawas Menelan Obat

    4

    Ketersediaan Obat

    5

    Pencatatan Pelaporan

  • Cure rate tinggi (pemutusan

    rantai transmisi)

    Paling cost effective (Bank

    Dunia)

    Rekomendasi WHO

  • Tujuh Strategi Utama Program Nasional Penanggulangan TB

    Equitable Quality DOTS Expansion Indonesia

    Ekspansi Quality DOTS 1. Perluasan & Peningkatan pelayanan DOTS

    berkualitas

    2. Menghadapi tantangan baru, TB-HIV, MDR-TB dll

    3. Melibatkan Seluruh Penyedia Pelayanan

    4. Melibatkan Penderita & Masyarakat

    Didukung dg Penguatan Sistem kesehatan

    5. Penguatan Policy & Kepemilikan Daerah

    6. Kontribusi thd Sistem Pelayanan Kesehatan

    7. Penelitian Operasional

  • SEMBUH

  • TB management in Indonesia

    PHCs

    Government Private

    Private practices

    Private hospitals

    Government hospitals

    Healthcare providers

    BP4 RSP

    GP Pulm

    DOTS strategy

  • HOSPITAL DOTS LINKAGE (HDL)

    TB IN HOSPITALS Case finding : high

    (DIY: hospital 36%; PHCs 27%; BP4 37%)

    Have no working area

    Case holding: low high dropped out (>50%)

    Low cure rate (< 50%)

  • SITES OF DIAGNOSIS OF TB

    IN HOSPITAL

  • District Health

    Service Hospitals

    Lung Clinics PPTI Clinics,

    WP,Lapas/Rutan

    Community

    Leader

    PKK, PPTI

    NGO

    Private Doctors CHC

    PRM / PPM

    EXTERNAL NETWORKING

  • Option of TB management in HDL

    Option Suspect finding

    Diagnosis Treatment initiation

    Continuing treatment

    Consultation Recording and reporting

    1.

    2.

    3.

    4.

    Hospital/non PHC

    PHC

  • Alur Rujukan Penderita Tuberkulosis

    Rumah Sakit Puskesmas

    Koordinator

    HDL Kab/Kota

    Penderita, OAT,

    TB.01, surat

    rujukan (TB.09)

    Wasor TBC

    Kab/Kota

    informasikonfirmasi

    (TB.09)

    REFERAL SYSTEM IN HDL

  • World problems of Tuberculosis (TB)

    The second global cause of death from infectious

    agents

    Neglected Childhood TB

    Low Case Detection Rate

    Lack of holistic approach of TB management

    Non-standardized management

  • Non-standardized management

    Diagnosis

    Treatment

    Public Health

    irrational treatment

    over diagnosis

    underdiagnosis

    contact tracing

    Recording and reporting

  • ISTC (International Standard for TB care)

    Differ from existing guidelines

    standards what should be done

    guidelines how the action is to be accomplished

    Evidence-based, living document

    As a complementary of the existing guideline

  • Purpose of ISTC

  • ISTC

    Diagnosis

    Treatment

    2 standards Public Health

    6 standards

    9 standards

  • Standards for Diagnosis Pediatric considerations

  • Standard 1

    All persons with otherwise unexplained productive cough lasting two-three weeks or more should be evaluated for TB

    COUGH is NOT the main symptom of TB Other symptoms should be considered:

    weight loss or FTT in the last two months fever >2 weeks with unexplained causes Close contact with adult Pulmonary TB

    Pediatric consideration

  • Standard 4

    All persons with

    chest radiographic

    findings suggestive

    of TB should have

    sputum specimens

    submitted for

    microbiological

    examination.

    Collecting sputum in children is challenging

    If possible, perform induced sputum

    or gastric lavage

    Pediatric consideration

  • Standard 6

    The diagnosis of

    intra-thoracic TB in

    symptomatic

    children with

    negative sputum

    smears should be

    based on the

    finding of chest

    radiograph

    The appearance of

    lymphadenopathy is

    subtle and may be

    difficult to detect

    especially in

    malnourished children

    and when there is HIV-

    related pulmonary disease.

    Pediatric consideration

  • Standards for Treatment pediatric considerations

  • Standard 8

    All patients (incl those

    with HIV infection) .....

    regimen using drugs of

    known bioavailability.

    The initial phase should

    consist of two months

    of isoniazid, rifampicin,

    pyrazinamide, and

    ethambutol.

    Triple drugs:

    INH, Rif and PZA

    Four or five drugs for severe TB

    Pediatric consideration

  • Standards for Public Health

  • ISTC Standard 16

    All providers of care for patients with TB should ensure that persons (especially children under 5

    year of age and persons with HIV infection) who are in close contact with patients who have infectious

    TB are evaluated and managed in line with international recommendations.

  • ISTC Standard 16

    Children under 5 years of age and persons with HIV infection who have been in contact with an infectious case should be evaluated for both latent infection with M. tb and for active TB.

  • ISTC Standard 17

    All providers must report both new and retreatment TB cases and their treatment outcomes to local public health authorities, in conformance with applicable legal requirements and policies.

  • Together in partnership we are more than the sum of our parts!