Rural Physicians' Experiences with Diagnosis, Treatment, and Management of Pediatric Tuberculosis Before and After Disasters in Bohol

• Published in: Journal of Philippine development 2022-07, Vol.46 (2), p.49-70
• Main Authors: Castillo-Carandang, Nina T, Leining, Lauren M, Mandalakas, Anna Maria, Murray, Kristy O, Liao, Jo Anne Claire M, Cabatos-Riña, Maureen Mae, Gatchalian, Salvacion R
• Format: Article
• Language: English
• Subjects: Females; Health care delivery; International organizations; International taxation; Males; Medical diagnosis; Pediatrics; Physicians; Prevention; Public health; Rural areas; Surveillance; Tuberculosis
• ISSN: 2508-0954; 2508-0849

Tuberculosis (TB) is the sixth leading cause of death in the Philippines, a country that accounts for 7 percent of the world TB case detection gap. Achieving TB elimination milestones is contingent on strong national surveillance and healthcare delivery. This paper highlights the experiences of rural physicians from Bohol in managing pediatric TB cases before and after disasters. The participants are physicians from public and private healthcare systems in municipalities heavily affected and less affected by an earthquake and the super typhoon that struck the province in 2013. The discussions focus on the burden, diagnosis, treatment, management, and referral of pediatric TB cases and how their circumstances changed before, during, and after the recovery period in 2016. This study found that the situation of pediatric TB before and after the disasters was almost unchanged. Both healthcare sectors still struggled with stockouts of diagnostic supplies and medications, which resulted in the disruption of TB diagnosis and treatment and loss to follow-up among patients. The disasters further exacerbated these challenges.Clinicians primarily rely on signs and symptoms for pediatric TB diagnosis. However, some of them have not received training in the past years. There was also a shortage of trained personnel across all levels of the healthcare system. The rural physicians recognize the value of developing protocols for managing TB patients during emergencies and disasters, conducting regular training of staff, formalizing partnerships between the public and private healthcare systems, and continuously orienting and soliciting the assistance of local government officials on health concerns and funding to prevent stockouts. The goals outlined by the World Health Organization's End TB Strategy can be achieved by increasing stewardship through stakeholder collaboration, eliminating stockouts, and ensuring better diagnostics and treatment options. The results from the group discussions provide an opportunity to examine the strengths, weaknesses, opportunities, and threats in the diagnosis, control, and treatment of TB among children in an island province with a high TB burden.