Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

Primary immunization coverage among Migrant children in the age group of 12 to 23 months in Sriperumbudur Taluk, Kanchipuram District

Background: Migrants carry with them a burden of health risks and public health implications due to their poverty, unequal access to social benefits including health care services like immunization.&nbsp;Aims &amp; Objectives: To describe the socio-demographic profile and the primary immunization status of migrant children in the age group 12 to 23 months and also identify the various factors related to immunization failure if any in Sriperumbudur Taluk, Kanchipuram District of Tamil Nadu.&nbsp;Material &amp; Methods: A community based cross sectional descriptive study was done among 173 migrant children in the age group of 12 to 23 months from 12 construction sites in the study area between July 2016 – September 2016. The data was collected using a pre-designed, structured questionnaire.&nbsp;Results: The age group of mothers varied from 18-39yrs. About 46 (26.6%) mothers were illiterate. Majority of the children 159 (91.9%) had a birth certificate. Almost all 171 (98.8%) children were having immunization card. Only one child was found to be partially immunized. Lack of time was found to be the reason for not taking the child for immunization. All others 172 (99.4%) were fully immunized.&nbsp;Conclusion: Awareness should be created among migrant workers regarding importance of immunization through regular health education activities

Primary immunization coverage among Migrant children in the age group of 12 to 23 months in Sriperumbudur Taluk, Kanchipuram District

Background: Migrants carry with them a burden of health risks and public health implications due to their poverty, unequal access to social benefits including health care services like immunization.&nbsp;Aims &amp; Objectives: To describe the socio-demographic profile and the primary immunization status of migrant children in the age group 12 to 23 months and also identify the various factors related to immunization failure if any in Sriperumbudur Taluk, Kanchipuram District of Tamil Nadu.&nbsp;Material &amp; Methods: A community based cross sectional descriptive study was done among 173 migrant children in the age group of 12 to 23 months from 12 construction sites in the study area between July 2016 – September 2016. The data was collected using a pre-designed, structured questionnaire.&nbsp;Results: The age group of mothers varied from 18-39yrs. About 46 (26.6%) mothers were illiterate. Majority of the children 159 (91.9%) had a birth certificate. Almost all 171 (98.8%) children were having immunization card. Only one child was found to be partially immunized. Lack of time was found to be the reason for not taking the child for immunization. All others 172 (99.4%) were fully immunized.&nbsp;Conclusion: Awareness should be created among migrant workers regarding importance of immunization through regular health education activities