Indications for referral and hospitalization

All children and adolescents with severe forms of TB (TBM, peritonitis, pericarditis, renal, spinal, disseminated or osteoarticular TB) and those suspected of having MDR/RR-TB (in contact with a person with confirmed or suspected MDR/RR-TB, or children and adolescents diagnosed with TB who are not responding to first-line TB treatment) should be referred to a specialist for further management if management capacity where they present is insufficient.

Hospitalization should be reserved for children and adolescents where this is clinically indicated. Children and adolescents with medicine toxicity resulting in treatment discontinuation should be referred to the appropriate level of care as needed. Children who present with IMCI danger signs should be referred for immediate hospitalization (80).

Box 5.8

After discharge from hospital, if treatment is continued at a PHC facility it is important that dosages recommended by the referral centre are followed and clear communication established between the hospital and PHC facility. All patients should be registered and notified to the NTP, either at the hospital or at the PHC facility.

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