Effect of decentralising childhood tuberculosis diagnosis to primary health centre versus district hospital levels on disease detection in children from six high tuberculosis incidence countries: an operational research, pre-post intervention study

被引：0

作者：

Wobudeya, Eric ^{[1
]}

Nanfuka, Mastula ^{[1
]}

Nguyet, Minh Huyen Ton Nu ^{[2
]}

Taguebue, Jean-Voisin ^{[3
]}

Moh, Raoul ^{[4
,5
]}

Breton, Guillaume ^{[6
]}

Khosa, Celso ^{[7
]}

Borand, Laurence ^{[8
]}

Mwanga-Amumpaire, Juliet ^{[9
]}

Mustapha, Ayeshatu ^{[10
]}

Nolna, Sylvie Kwedi ^{[11
]}

Komena, Eric ^{[5
]}

Mugisha, Jacob Ross ^{[12
]}

Natukunda, Naome ^{[9
]}

Dim, Bunnet ^{[8
]}

de Lauzanne, Agathe ^{[8
]}

Cumbe, Saniata ^{[7
,22
]}

Balestre, Eric ^{[2
]}

Poublan, Julien ^{[2
]}

Lounnas, Manon ^{[13
]}

Ngu, Eden ^{[14
]}

Joshi, Basant ^{[2
]}

Norval, Pierre-Yves ^{[15
]}

Terquiem, Etienne Leroy ^{[15
]}

Turyahabwe, Stavia ^{[16
]}

Foray, Lynda ^{[17
]}

Sidibe, Souleymane ^{[18
]}

Albert, Kuate Kuate ^{[19
]}

Manhica, Ivan ^{[20
]}

Sekadde, Moorine ^{[16
]}

Detjen, Anne ^{[21
]}

Verkuijl, Sabine ^{[21
]}

Mao, Tan Eang ^{[23
]}

Orne-Gliemann, Joanna ^{[2
]}

Bonnet, Maryline ^{[11
]}

Marcy, Olivier ^{[2
]}

机构：

[1] MU JHU Care Ltd, MU JHU Res Collaborat, Kampala, Uganda

[2] Univ Bordeaux, Natl Inst Hlth & Med Res, Res Inst Sustainable Dev IRD, INSERM,U1219,EMR 271, Bordeaux, France

[3] Chantal Biya Fdn, Mother & Child Ctr, Yaounde, Cameroon

[4] Felix Houphouet Boigny Univ, Teaching Unit Dermatol & Infectiol, UFR Med Sci, Abidjan, Cote Ivoire

[5] CHU Treichville, Programme PAC CI, Abidjan, Cote Ivoire

[6] SOLTHIS, Paris, France

[7] Inst Nacl Saude, Marracuene, Mozambique

[8] Inst Pasteur Cambodge, Epidemiol & Publ Hlth Unit, Clin Res Grp, Phnom Penh, Cambodia

[9] Epictr Mbarara Res Ctr, Mbarara, Uganda

[10] Ola Childrens Hosp, Freetown, Sierra Leone

[11] Univ Montpellier, Trans VIHMI, INSERM, IRD, Montpellier, France

[12] SOLTHIS, Freetown, Sierra Leone

[13] Univ Montpellier, IRD, CNRS, MIVEGEC, Montpellier, France

[14] Ctr Pasteur Cameroun, Yaounde, Cameroon

[15] Soutien Pneumol Int, Tech Assistance Management, Bordeaux, France

[16] Natl TB & Leprosy Program, Kampala, Uganda

[17] Sierra Leone NTP, Freetown, Sierra Leone

[18] Cote Ivoire NTP, Abidjan, Cote Ivoire

[19] Cameroon NTP, Yaounde, Cameroon

[20] Mozamb NTP, Maputo, Mozambique

[21] UNICEF, Hlth Programme, New York, NY USA

[22] WHO, Global TB Programme, Geneva, Switzerland

[23] Cambodia NTP, Phnom Penh, Cambodia

来源：

ECLINICALMEDICINE | 2024年 / 70卷

关键词：

Decentralisation; Child; Tuberculosis; Diagnosis; XPERT MTB/RIF; PULMONARY TUBERCULOSIS; FEASIBILITY; MULTICENTER; ACCURACY; SPECIMEN; SERVICES; POINT;

D O I：

10.1016/j.eclinm.2024.102527

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Childhood tuberculosis (TB) remains underdiagnosed largely because of limited awareness and poor access to all or any of specimen collection, molecular testing, clinical evaluation, and chest radiography at low levels of care. Decentralising childhood TB diagnostics to district hospitals (DH) and primary health centres (PHC) could improve case detection. Methods We conducted an operational research study using a pre-post intervention cross-sectional study design in 12 DHs and 47 PHCs of 12 districts across Cambodia, Cameroon, C & ocirc;te d'Ivoire, Mozambique, Sierra Leone and Uganda. The intervention included 1) a comprehensive diagnosis package at patient-level with tuberculosis screening for all sick children and young adolescents <15 years, and clinical evaluation, Xpert Ultra-testing on respiratory and stool samples, and chest radiography for children with presumptive TB, and 2) two decentralisation approaches (PHC-focused or DH-focused) to which districts were randomly allocated at country level. We collected aggregated and individual data. We compared the proportion of tuberculosis detection in children and young adolescents <15 years pre-intervention (01 August 2018-30 November 2019) versus during intervention (07 March 2020-30 September 2021), overall and by decentralisation approach. This study is registered with ClinicalTrials.gov, NCT04038632. Findings TB was diagnosed in 217/255,512 (0.08%) children and young adolescent <15 years attending care pre-intervention versus 411/179,581 (0.23%) during intervention, (OR: 3.59 [95% CI 1.99-6.46], p-value<0.0001; p-value = 0.055 after correcting for over-dispersion). In DH-focused districts, TB diagnosis was 80/122,570 (0.07%) versus 302/86,186 (0.35%) (OR: 4.07 [1.86-8.90]; p-value = 0.0005; p-value = 0.12 after correcting for over-dispersion); and 137/132,942 (0.10%) versus 109/93,395 (0.11%) in PHC-focused districts, respectively (OR: 2.92 [1.25-6.81; p-value = 0.013; p-value = 0.26 after correcting for over-dispersion). Interpretation Decentralising and strengthening childhood TB diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant.

引用

页数：12