New health domains are coming, but unfortunately they will likely be awarded to a set of private companies that have no experience or interest in public health.  ICANN’s recent decision to ignore multiple calls from the public health community, World Health Organizations, World Medical Association, countries like France and Mali, and other stakeholders means that a new .health top level domain will soon be on the Internet, along with other health-related domains (such as .med, .healthcare, .doctor, etc.).  However, these domains will be operated with virtually no restrictions and by companies in the business of generating profit, not quality and reliable health information.  See our previous work on the .health and other health-related domains in work in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62215-1/fulltext ) and the Journal of Medical Internet Research (http://www.jmir.org/2014/3/e62/ )

Specifically, on 6 June 2014, ICANN’s New gTLD Program Committee, who is empowered to make board-level decisions regarding new ‘generic-top level domain names’ (think existing .com and .biz, but now being expanded to .health, .doctor, .clinic, .healthcare) announced that it would take no action to protect or provide additional safeguards for health domains despite multiple warnings and a call for a halt to their award process.  In their decision they noted objections from the World Health Organization and others, but stated that there were ‘no noted objections to move forward’ (see:  https://www.icann.org/resources/board-material/prelim-report-new-gtld-2014-06-06-en ).

This decision means that the .health will be auctioned away to the highest bidder of 3 private companies in September, a move that could have disastrous impacts on the right to quality and reliable health information.  We’ve called for action in our prior research, and now are calling for it again.  Unless drastic action is taken, ICANN will continue to ignore public health in favor of profits and unregulated Internet expansion.

Timothy Ken Mackey, MAS, PhD

Assistant Professor, UC San Diego, School of Medicine

Associate Director, MAS Program in Health Policy and Law

Director, Global Health Policy Institute

Website:  www.ghpolicy.org  

Linkedin Profile

MyMobileUniversity is an initiative by LTT Global a global pioneer in mobile learning to impact lives globally through education. It is a FREE learning platform for all ages, making available content from ages 2 upwards covering academic, lifestyle and lifelong learning. Everyone gets an opportunity to learn something new, up-skill or re-skill themselves at their own time and money and time is no longer an issue. MyMobileUni.com’s platform makes it a one-stop centre to access FREE and quality learning content. We have links to the world’s leading Massive Open Online Courses (MOOC) providers like Coursera, edX and Udacity. We also have access to other universities, organizations and subject matter experts from all over the world who have content that they like to share with the world.’ http://mymobileuni.com/ 

The Global Health Workforce Alliance has published the official report of the Third Global Forum on Human Resources for Health. Below are extracts from the executive summary, I have also added the report’s 10 point agenda, together with (for comparison) the 7-point agenda from our pre-Recife discussion on HRH here on the HIFA forum (HIFA was the official platform for global discussions in the weeks leading up to Recife).

Human Resources for Health: foundation for Universal Health Coverage and the post-2015 development agenda http://www.who.int/workforcealliance/knowledge/resources/report3rdgf/en/

‘This report describes the proceedings and main outcomes of the Third Global Forum on Human Resources for Health, which was jointly convened by the Government of Brazil, WHO, the Pan American Health Organization (PAHO) and the Global Health Workforce Alliance in Recife, Brazil, from 10 to 13 November 2013. The event, organized around the theme of Human Resources for Health: Foundation for Universal Health Coverage and the Post-2015 Development Agenda, provided an opportunity to bolster political commitment and to update the human resources for health agenda, to make it more relevant to the current global health policy discourse, including the push towards the health Millennium Development Goals, the universal health coverage objective and the post-2015 agenda.’

‘In addition, countries and human resources for health stakeholders were invited to make explicit commitments related to human resources for health to accelerate efforts on their national health development agendas as the basis for an inclusive mutual accountability framework.’

‘With 1800 participants and attendees from 93 Member States, including more than 40 ministers and/or deputy ministers, the Third Global Forum was the largest ever human resources for health event. The conference had a dual nature: a technical event to share new evidence, best practices and lessons learned among experts and planners in human resources for health; and a political one to galvanize the support of policy-makers.’ […]

‘The Third Global Forum showed that the global community must significantly and ambitiously raise the bar in its efforts: aiming much higher in terms of the political will, good governance and financial and other resources committed to address challenges related to human resources for health. A holistic agenda on human resources for health instrumental to attaining universal health coverage will require interconnected efforts at the national and global levels in support of four main areas of action:

• anticipate and adapt to new challenges;

• articulate ambitious targets with a long time horizon (10–15 years), including producing larger number of health workers and establishing benchmarks for the performance of higher education and employment;

• broaden participation in policy development and response beyond the public health sector by engaging other key constituencies and sectors and create accountability mechanisms to support and oversee implementation; and

• innovate through more efficient and rational planning and use of financial and human resources in the health sector and towards more results-focused implementation. […]

‘The Recife Political Declaration on Human Resources for Health, adopted by representatives of Member States attending the Third Global Forum, was the ultimate outcome of the event and enshrined these principles, marking the beginning of a new era in human resources for health. The Recife Declaration recognized the centrality of human resources for health in the drive towards achieving universal health coverage. It reaffirmed the vision that all people everywhere must have access to a skilled, motivated and facilitated health worker within a robust health system; it committed governments to creating the conditions for the inclusive development of a shared vision with other stakeholders; and it reaffirmed the role of the WHO Global Code of Practice on the International Recruitment of Health Personnel as a guide for action to strengthen the health workforce and health systems. Further, it identified a range of actions, including improving planning, education, management, governance, information systems and the adoption of innovative approaches, to be implemented in accordance with countries’ contexts and needs. The political statements made in the Recife Declaration, matched by the more than 80 commitments by WHO Member States and Global Health Workforce Alliance member organizations, are the best measure of the success of the Third Global Forum on Human Resources for Health in bolstering political commitment for the health workforce agenda and represent a shared platform and common startingpoint for further policy dialogue and action on developing human resources for health in the years ahead.’ […]

‘The report presents a 10-point agenda [for action]:

1. Recognize the centrality of the health workforce in translating the universal health coverage vision into improved health care on the ground.

2. Assess the gap between the need for a health workforce, actual supply and the population’s demand for health services.

3. Formulate human resources for health policy objectives that encapsulate the vision for the health system and services.

4. Build the data, evidence base and strategic intelligence required to implement and monitor the policy objectives and to sustain effective management.

5. Build and sustain the technical capacity to design, advocate for and implement policies.

6. Build political support at the highest level to ensure continuity in the pursuit of universal health coverage.

7. Reform the governance and institutional human resources for health environment.

8. Assess the cost of the various scenarios of health workforce reforms.

9. Encourage international partners to focus their support and to report on their official development assistance for building the capacity of health systems.

10. Encourage international partners to address transnational issues and strengthen global human resources for health governance, collaborative platforms and mechanisms.’

It is interesting to compare the 10-point agenda from Recife (above) with the 7-point agenda below that emerged from HIFA discussions before Recife (HIFA was the official platform for multi-stakeholder discussion in the run-up to Recife).

‘1. Funders should think more long-term

2. Support expansion and improvement of community health worker programmes

3. Governments should assume responsibility for HRH planning

4. Strengthen professional associations

5. Strengthen education and training

6. Address needs of laboratory professionals

7. Strengthen management and leadership.’

A 2-page summary of our discussions on HIFA is available here:

http://www.hifa2015.org/wp-content/uploads/GHWA-HIFA-Discussion-on-HRH.pdf 

Best wishes, Neil

HIFA profile: Neil Pakenham-Walsh is the coordinator of the HIFA campaign (Healthcare Information For All) and co-director of the Global Healthcare Information Network. He is also currently chair of the Dgroups Foundation (www.dgroups.info), a partnership of 18 international development organisations promoting dialogue for international health and development. He started his career as a hospital doctor in the UK, and has clinical experience as an isolated health worker in rural Ecuador and Peru.  For the last 20 years he has been committed to the global challenge of improving the availability and use of relevant, reliable healthcare information for health workers and citizens in low- and middle-income countries. He is also interested in the wider potential of inclusive, interdisciplinary communication platforms to help address global health and international development challenges. He has worked with the World Health Organization, the Wellcome Trust, Medicine Digest and INASP (International Network for the Availability of Scientific Publications). He is based near Oxford, UK. www.hifa2015.org  neil.pakenham-walsh AT ghi-net.org

On behalf of the Centers for Disease Control and Prevention (CDC), I am pleased to announce the release of a new CDC Blast Injury mobile application to assist in the response and clinical management of injuries resulting from terrorist bombings and other mass casualty explosive events. The application provides clear, concise, up-to-date medical and healthcare systems information to assist healthcare providers and public health professionals in the preparation, response, and management of injuries resulting from terrorist bombing events. We invite you and your organization to join us for a Google+ Hangout on June 30th at 11:30 EDT as we discuss this new tool. You can RSVP and join the Hangout here: https://plus.google.com/+CDC

Download the mobile application for free today from the iTunes store: https://itunes.apple.com/au/app/cdc-blast-injury/id890434999?mt=8&ign-mpt=uo%3D2

We hope that you can join us on June 30th as we launch the CDC Blast Injury mobile application.

Forwarded by Nand Wadhwani

The Mother and Child Health and Education Trust

http://motherchildtrust.org  |  http://healthphone.org

A new paper in the WHO Bulletin (free access) suggests that SMS text messages are more effective (and probably much less expensive) than a 1-day workshop to promote rational prescribing of antibiotics. Below is the citation and selected extracts.

CITATION:

Yaolong Chen et al. Use of text messages to communicate clinical recommendations to health workers in rural China: a cluster-randomized trial. Bull World Health Organ 2014;92:474–481 | doi: http://dx.doi.org/10.2471/BLT.13.127076

http://www.who.int/bulletin/volumes/92/7/13-127076.pdf

ABSTRACT

Objective: To compare the effectiveness of mobile phone text messaging and that of traditional health worker training in communicating clinical recommendations to health workers in China.

Methods: A cluster-randomized controlled trial (Chinese Clinical Trial Register: ChiCTR-TRC-09000488) was conducted in 100 township health centres in north-western China between 17 October and 25 December 2011. Health workers were allocated either to receive 16 text messages with recommendations on the management of viral infections affecting the upper respiratory tract and otitis media (intervention

group, n = 490) or to receive the same recommendations through the existing continuing medical education programme – a one-day training workshop (control group, n = 487). Health workers’ knowledge of the recommendations was assessed before and after messaging and traditional training through a multiple choice questionnaire. The percentage change in score in the control group was compared with that in the intervention group. Changes in prescribing practices were also compared.

Findings: Health workers’ knowledge of the recommendations increased significantly in the intervention group, both individually (0.17 points; 95% confidence interval, CI: 0.168–0.172) and at the cluster level (0.16 points; 95% CI: 0.157–0.163), but not in the control group. In the intervention group steroid prescriptions decreased by 5 percentage points but antibiotic prescriptions remained unchanged. In the control group, however, antibiotic and steroid prescriptions increased by 17 and 11 percentage points, respectively.

Conclusion: Text messages can be effective for transmitting medical information and changing health workers’ behaviour, particularly in resource-limited settings

SELECTED EXTRACTS (selected by Neil PW)

‘Health workers in rural China do not receive systematic, qualified medical education and training1,2 because, unlike their urban counterparts, they face constraints such as inadequacies in transport and funding and they are largely unaware of the need for education.’

‘This study shows that compared with traditional methods of medical education, text messages are more effective in leading to a greater understanding of recommendations, especially for family physicians, a result that was shown by changes in prescribing practices.’

Best wishes, Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge: Join HIFA www.hifa2015.org

HealthPhone™ is a personal video reference library and guide to better health and nutrition practices, for families and communities, including the illiterate, in their language, distributed on mobile phones…..more

Establishing and Using Data Standards in Health Workforce Information Systems

Over the last nine years, the USAID-funded CapacityPlus global project and its predecessor, the Capacity Project, have worked with countries to adapt and implement human resources information systems (HRIS) to better track and support their health workforces. HRIS are only valuable, however, to the extent that stakeholders use them for policy and management decisions, and can only be deemed successful if the decisions in turn lead to better health care. Both criteria wholly depend on the quality of data in the system.

In the context of HRIS, data quality is best defined as how well the data represent the real world (Brown 2011). Poor data quality can adversely affect support for—and even the livelihoods of—the very health workers we want the systems to benefit. Low-quality data can also influence organizational, project, or donor indicators. A national HRIS typically involves numerous data collection and entry steps and many users countrywide, all of which pose challenges to ensuring data quality (Wakibi 2008). As countries move ahead with HRIS scale-up efforts, it is important to establish and use standards (organizational, national, and international) to align and and harmonize the collection, aggregation, and analysis of human resources for health (HRH) data…..more

We’d like to let you know that we’ve just released the first 3 videos in our new Childbirth Series: Giving Good Care in Labor, Examining the Placenta, and The Position of the Baby http://globalhealthmedia.org/childbirth/childbirth-videos/ The primary audience for these teaching videos are birth attendants in developing countries. The videos showcase a midwifery approach to care with a birth attendant working solo, the norm in small facilities throughout much of the developing world. These films will soon be available in French and Spanish. They are downloadable free-of-charge for use in low-resource settings through our Creative Commons license. In an effort to improve our work we are grateful for any feedback, especially from those of you who are directly involved with training birth attendants.

Kind regards,

Deb

Deborah Van Dyke, Director

Global Health Media Project

802-496-7556

The World Health Organization’s Global Malaria Program has many FREE downloadable documents on everything from malaria case management, to safe insecticides, to the latest diagnostic tools. These are important references for any health worker in a malaria endemic environment.  Check out the many malaria publications at: WHO | Malaria http://www.who.int/malaria/en/

Citation: Basic or enhanced clinician training to improve adherence to malaria treatment guidelines: a cluster-randomised trial in two areas of Cameroon

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70201-3/fulltext

The Lancet Global Health, Volume 2, Issue 6, Pages e346 – e358, June 2014 <Previous Article|Next Article>

doi:10.1016/S2214-109X(14)70201-3

Wilfred F Mbacham, Lindsay Mangham-Jefferies, Bonnie Cundill, Olivia A Achonduh, Clare I R Chandler, Joel N Ambebila, et al.

ABSTRACT

Background: The scale-up of malaria rapid diagnostic tests (RDTs) is intended to improve case management of fever and targeting of artemisinin-based combination therapy. Habitual presumptive treatment has hampered these intentions, suggesting a need for strategies to support behaviour change. We aimed to assess the introduction of RDTs when packaged with basic or enhanced clinician training interventions in Cameroon.

Methods: We did a three-arm, stratified, cluster-randomised trial at 46 public and mission health facilities at two study sites in Cameroon to compare three approaches to malaria diagnosis. Facilities were randomly assigned by a computer program in a 9:19:19 ratio to current practice with microscopy (widely available, used as a control group); RDTs with a basic (1 day) clinician training intervention; or RDTs with an enhanced (3 days) clinician training intervention. Patients (or their carers) and fieldworkers who administered surveys to obtain outcome data were masked to study group assignment. The primary outcome was the proportion of patients treated in accordance with WHO malaria treatment guidelines, which is a composite indicator of whether patients were tested for malaria and given appropriate treatment consistent with the test result. All analyses were by intention to treat. This study is registered at ClinicalTrials.gov, number NCT01350752.

Findings: The study took place between June 7 and Dec 14, 2011. The analysis included 681 patients from nine facilities in the control group, 1632 patients from 18 facilities in the basic-training group, and 1669 from 19 facilities in the enhanced-training group. The proportion of patients treated in accordance with malaria guidelines did not improve with either intervention; the adjusted risk ratio (RR) for basic training compared with control was 1·04 (95% CI 0·53—2·07; p=0·90), and for enhanced training compared with control was 1·17 (0·61—2·25; p=0·62). Inappropriate use of antimalarial drugs after a negative test was reduced from 84% (201/239) in the control group to 52% (413/796) in the basic-training group (unadjusted RR 0·63, 0·28—1·43; p=0·25) and to 31% (232/759) in the enhanced-training group (0·29, 0·11—0·77; p=0·02).

Interpretation: Enhanced clinician training, designed to translate knowledge into prescribing practice and improve quality of care, has the potential to halve overtreatment in public and mission health facilities in Cameroon. Basic training is unlikely to be sufficient to support the behaviour change required for the introduction of RDTs.

As part of our exploration of the information and learning needs of Community Health Workers, supported by mPowering Frontline Health Workers, please find below a new paper about Community Health Workers in Zambia, published in the open access journal Human Resources for Health.

Best wishes, Neil Pakenham-Walsh, HIFA moderator

Hope and despair: community health assistants’ experiences of working in a rural district in Zambia

Joseph Mumba Zulu, John Kinsman, Charles Michelo and Anna-Karin Hurtig

Human Resources for Health 2014, 12:30  doi:10.1186/1478-4491-12-30

Published: 25 May 2014

Abstract (provisional)

Background: In order to address the challenges facing the community-based health workforce in Zambia, the Ministry of Health implemented the national community health assistant strategy in 2010. The strategy aims to address the challenges by creating a new group of workers called community health assistants (CHAs) and integrating them into the health system. The first group started working in August 2012. The objective of this paper is to document their motivation to become a CHA, their experiences of working in a rural district, and how these experiences affected their motivation to work.

Methods: A phenomenological approach was used to examine CHAs’ experiences. Data collected through in-depth interviews with 12 CHAs in Kapiri Mposhi district and observations were analysed using a thematic analysis approach.

Results: Personal characteristics such as previous experience and knowledge, passion to serve the community and a desire to improve skills motivated people to become CHAs. Health systems characteristics such as an inclusive work culture in some health posts motivated CHAs to work. Conversely, a non-inclusive work culture created a social structure which constrained CHAs’ ability to learn, to be innovative and to effectively conduct their duties. Further, limited supervision, misconceptions about CHA roles, poor prioritisation of CHA tasks by some supervisors, as well as non- and irregular payment of incentives also adversely affected CHAs’ ability to work effectively. In addition, negative feedback from some colleagues at the health posts affected CHA’s self-confidence and professional outlook. In the community, respect and support provided to CHAs by community members instilled a sense of recognition, appreciation and belonging in CHAs which inspired them to work. On the other hand, limited drug supplies and support from other community-based health workers due to their exclusion from the government payroll inhibited CHAs’ ability to deliver services.

Conclusions: Programmes aimed at integrating community-based health workers into health systems should adequately consider multiple incentives, effective management, supervision and support from the district. These should be tailored towards enhancing the individual, health system and community characteristics that positively impact work motivation at the local level if such programmes are to effectively contribute towards improved primary healthcare.

SELECTED EXTRACTS (selected by Neil PW)

‘Delayed communication of important information to CHAs by a few supervisors also demoralised CHAs. For example, it was reported that some supervisors shelve important documents instead of giving them to CHAs upon receiving them from the MoH.

‘So it’s today that I have found a certain CHA implementation book. I asked her (supervisor) when it came and she said a long time ago. There are also other materials that came in October last year and we are only seeing them now in May.’ (CHA 6, male).

‘The way we are working with the neighbourhood health committee, we are not comfortable… they are not regarding us as trained staff. So they regard the cashier, watchman and cleaner as people who have better information. (CHA 3, male).’

http://commons.wikimedia.org/wiki/File:Gambia_in_its_region.svg#mediaviewer/File:Gambia_in_its_region.svg

A paper in the African Journal of Reproductive Health looks at barriers to Skilled Birth Attendance in Gambia. As would be expected the main barriers are lack of time to go to a health centre and/or lack of transport. Three in four are attended by traditional birth attendants. I was surprised to learn that only 3% of women thought that the TBAs knew what to do in the event of complications, despite the fact that TBAs in larger villages routinely receive government training.

CITATION: Barriers to Skilled Birth Attendance: A Survey among Mothers in Rural Gambia.

Priya Miriam Lerberg et al.  Afr J Reprod Health 2014; 18[1]: 35-43

Full text: http://www.healthynewbornnetwork.org/sites/default/files/resources/lerberg.pdf

ABSTRACT

The objectives of this cross-sectional survey were to identify the most important barriers for use of skilled attendance during childbirth by women in rural Gambia. We also assessed information received during antenatal care, preparations made prior to childbirth, and experiences and perceptions that may influence the use of skilled birth attendance in rural Gambia. The most

frequently stated barriers for giving birth in a health facility were not having enough time to go (75%), and lack of transport (29%). The majority of the women (83%) stated that they preferred having a health worker attending their childbirth. More than seventy percent of the participants gave birth attended by a traditional birth attendant, but only 27% had intended to give birth at home. Sixty-four percent had made advance arrangements for the childbirth. Only 22% were informed about expected time of birth during antenatal care. Our findings suggest that the participants hold the knowledge and motivation that is necessary if practices are to be changed. Interventions aiming at ensuring timely transport of women to health facilities seem key to increased use of skilled birth attendants. (Afr J Reprod Health 2014; 18[1]: 35-43).

SELECTED EXTRACTS

‘Villages with more than 400 inhabitants have resident TBAs that have received government-supported training’

‘Three out of four respondents reported that they were assisted by a TBA during childbirth. Eighty three percent said they would have preferred being assisted by someone else than the person who had assisted them, and most would have wanted a health professional. Four out of five mentioned skills and access to drugs as important reasons for wanting a health professional present during childbirth. Health personnel’s ability to handle complications was emphasised by two out of three respondents.’

‘Practically all (99%) agreed when asked if doctors and nurses are knowledgeable about the care a woman need, and 97% agreed that TBAs are.’

‘We asked the participants if they thought nurses/doctors/TBAs know what to do in case of complications: 99.5% agreed that doctors know what to do, 99% agreed that nurses know, and only three percent thought that the TBAs know what to do.’

Best wishes,

Neil

Let’s build a future where people are no longer dying for lack of healthcare knowledge:  Join HIFA:    www.hifa2015.org

At 10, the toothless Pan African Parliament remains little more than a noble concept…..1 2

ANC leaders are anxious about the economy. The party’s national executive committee (NEC) lekgotla, which was held shortly after Standard & Poor’s downgraded SA’s rating and after a slew of other economic data confirmed the precarious position of the economy, raised concerns about government’s policy uncertainty and how this was undermining investment…..1 2 3

Economic transformation will take centre stage during this term, says Deputy President Cyril Ramaphosa. “Economic transformation must and will take centre stage during this new term of government,” Ramaphosa told a national Youth Day commemoration in Galeshewe, in the Northern Cape today. He said the youth must be at the centre of this economic transformation…..1 2 3 4

Wits University has revised its admissions policy for all programmes offered by the Faculty of Health Sciences. This follows the recommendations of a task team commissioned by the Vice-Chancellor….more

Overall messages

• Skilled health worker migration has emerged as a major issue in global policy making over the last decade. Global dialogue on skilled health worker migration takes place through a range of multilateral organisations, with different missions and remits, inside and outside the UN system
• Evolving global policy on migration for development, universal health coverage and HRH in the post‐2015 development agenda are shaping global dialogue on HRH migration in tangible ways.
• Global governance on HRH migration has led to a range of global, regional and bilateral mechanisms resulting in varying levels of cooperation and policy development. They include normative frameworks for rights‐based approaches to migration, voluntary codes on ethical recruitment with a specific focus on HRH in source countries, diasporic initiatives aimed at ‘brain gain’ and development for source countries, data and forecasting on future HRH requirements, measures to ‘scale up’ HRH in source countries, and regional and bilateral agreements and partnerships on HRH migration, amongst others.
• This report argues that integrated and coordinated global responses are needed to address a range of policy issues concerning workforce planning, retention of health workers and mechanisms to ensure that source countries benefit from migration in ways that are proportionate to the benefits gained by destination countries. These are complex, multifaceted issues to address, not least because of the different policy domains under which global health and global migration have evolved, differences in health policy and financing in high‐, medium‐ and low income countries, and unequal economic and social development.Articulating what the ‘right to health’ and the ‘right to migrate’ mean in this context is equally complex.
• An overriding message from this report is that better are needed systems for: monitoring and capturing HRH requirements and HRH migration flows in source and destination countries; enforcing and monitoring ethical recruitment practices; ensuring that source countries benefit from global financial and technical assistance on HRH across a health system; facilitating reciprocal HRH arrangements and partnerships between source and destination countries; and promoting multistakeholder alliances and partnerships. It raises key questions about how to progress HRH migration policy in the context of global health, shared/global social responsibility, ethical recruitment and rights‐based approaches to migration.

Yeates_Pillinger_HRHmigration_2013

StatsSA has just issued the General Household Survey 2013 for South Africa. This should be essential reading for anyone interested in knowing about community in South Africa. StatsSA GH Survey 2013

The South African Government has issued new TB Guidelines. Adult: NTCP_Adult_TB-Guidelines-27.5.2014 / Child: National-Childhood-TB-Guidelines-2013