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.

Autor:	Wobudeya E; MU-JHU Care Ltd, MUJHU Research Collaboration, Kampala, Uganda., Nanfuka M; MU-JHU Care Ltd, MUJHU Research Collaboration, Kampala, Uganda., Ton Nu Nguyet MH; University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France., Taguebue JV; Mother and Child Center, Chantal Biya Foundation, Yaoundé, Cameroon., Moh R; Teaching Unit of Dermatology and Infectiology, UFR of Medical Sciences, Felix-Houphouët Boigny University, Abidjan, Cote d'Ivoire.; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire., Breton G; SOLTHIS, Paris, France., Khosa C; Instituto Nacional de Saúde, Marracuene, Mozambique., Borand L; Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia., Mwanga-Amumpaire J; Epicentre Mbarara Research Centre, Mbarara, Uganda., Mustapha A; Ola During Children's Hospital, Freetown, Sierra Leone., Nolna SK; TransVIHMI, University of Montpellier, IRD/INSERM, Montpellier, France., Komena E; Programme PAC-CI, CHU de Treichville, Abidjan, Côte d'Ivoire., Mugisha JR; SOLTHIS, Sierra Leone., Natukunda N; Epicentre Mbarara Research Centre, Mbarara, Uganda., Dim B; Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia., de Lauzanne A; Epidemiology and Public Health Unit, Clinical Research Group, Institut Pasteur du Cambodge, Phnom Penh, Cambodia., Cumbe S; Instituto Nacional de Saúde, Marracuene, Mozambique., Balestre E; University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France., Poublan J; University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France., Lounnas M; University of Montpellier, IRD, CNRS, MIVEGEC, Montpellier, France., Ngu E; Centre Pasteur du Cameroun, Yaounde, Cameroon., Joshi B; University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France., Norval PY; Technical Assistance for Management/Soutien Pneumologique International, France., Terquiem EL; Technical Assistance for Management/Soutien Pneumologique International, France., Turyahabwe S; National TB and Leprosy Program, Uganda., Foray L; Sierra Leone NTP, Sierra Leone., Sidibé S; Côte d'Ivoire NTP, Côte d'Ivoire., Albert KK; Cameroon NTP, Cameroon., Manhiça I; Mozambique NTP, Mozambique., Sekadde M; National TB and Leprosy Program, Uganda., Detjen A; Health Programme, UNICEF, New York, USA., Verkuijl S; World Health Organization; Global Tuberculosis Programme, Geneva, Switzerland., Mao TE; Cambodia NTP, Cambodia., Orne-Gliemann J; University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France., Bonnet M; TransVIHMI, University of Montpellier, IRD/INSERM, Montpellier, France., Marcy O; University of Bordeaux, National Institute for Health and Medical Research (INSERM) U1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux, France.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2024 Mar 21; Vol. 70, pp. 102527. Date of Electronic Publication: 2024 Mar 21 (Print Publication: 2024).
DOI:	10.1016/j.eclinm.2024.102527
Abstrakt:	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, Côte 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. Funding Source: Unitaid, Grant number 2017-15-UBx-TB-SPEED. Competing Interests: All authors declare no competing interests. (© 2024 World Health Organization.)
Databáze:	MEDLINE
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