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.
Child
Decentralisation
Diagnosis
Tuberculosis
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Apr 2024
Apr 2024
Historique:
received:
22
09
2023
revised:
19
02
2024
accepted:
21
02
2024
medline:
30
4
2024
pubmed:
30
4
2024
entrez:
30
4
2024
Statut:
epublish
Résumé
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. 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. 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). Decentralising and strengthening childhood TB diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant. Unitaid, Grant number 2017-15-UBx-TB-SPEED.
Sections du résumé
Background
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
Decentralising and strengthening childhood TB diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant.
Funding source
UNASSIGNED
Unitaid, Grant number 2017-15-UBx-TB-SPEED.
Identifiants
pubmed: 38685921
doi: 10.1016/j.eclinm.2024.102527
pii: S2589-5370(24)00106-8
pmc: PMC11056389
doi:
Banques de données
ClinicalTrials.gov
['NCT04038632']
Types de publication
Journal Article
Langues
eng
Pagination
102527Investigateurs
Borand Laurence
(B)
de Lauzanne Agathe
(L)
Dim Bunnet
(D)
Heang Seyla
(H)
Kaing Sanary
(K)
Keang Chanty
(K)
L Y Socheat
(LY)
Meas Pichpiseth
(M)
Nhoueng Sovann
(N)
Pring Long
(P)
Sreng Vouchleang
(S)
Yin Song
(Y)
Sovan Saren
(S)
Phan Chanvirak
(P)
Chreng Chanra
(C)
Khoun Ratha
(K)
Rin Monicando
(R)
Pal Sophea
(P)
Nang Boraneath
(N)
Pom Rathakrun
(P)
Mao Tan Eang
(M)
Chhim Simoy
(C)
Touch Huot
(T)
Suon Kosal
(S)
Chum Saronn
(C)
Tok Kimhong
(T)
Pring Kimchorn
(P)
Krouch Satya
(K)
Chok Chean
(C)
Seun Sunleng
(S)
Phon Savtey
(P)
Nang Mai
(N)
Hun Kimda
(H)
Hong Vanny
(H)
Sok Dara
(S)
Chea Kosal
(C)
Chheang Bunthoeun
(C)
Sem Rino
(S)
Lay Lam
(L)
Say Haysan
(S)
Kem Pholly
(K)
Meng Sreyphal
(M)
Phorn Sokheng
(P)
Him Sreyvann
(H)
Pheach Peakdey
(P)
Kive Dalai
(K)
Sar Moeur
(S)
Kong Sreydy
(K)
Kong Seyha
(K)
Yorn Sreytouch
(Y)
Tes Soam
(T)
Kep Sophal
(K)
Leng Seroeung Heng Thy
(L)
Neak Savorn
(N)
Seng Sim
(S)
Pay Pheakna
(P)
Suon Sithan
(S)
Chan Sophanna
(C)
Um Dyna
(U)
Sin Savuth
(S)
Phan Sam
(P)
Kum Sarim
(K)
Khath Sokheng
(K)
Phem Pong
(P)
Sok Seyha
(S)
Ny Chanty
(N)
Leim Van
(L)
Pich Sereyvuth
(P)
Chheang Sengkry
(C)
Eang Nhin
(E)
Sao Vannareth
(S)
Sim Vannak
(S)
Som Sopheak
(S)
Pong Ney
(P)
Van Sokha
(V)
Seng Sreyleap
(S)
Yoeurng Vanna
(Y)
Toem Kakada
(T)
Keo Thida
(K)
Sem Vuochny
(S)
Veng Sophal
(V)
Rin Chanthol
(R)
Seang Vanny
(S)
Lok Kiri
(L)
Mao Khemra
(M)
Ouk Keovanna
(O)
Min Maiya
(M)
Morm Suomun
(M)
Koy Rattana
(K)
Chhann Sreypov
(C)
Set Sreytouch
(S)
Amboua Schouame Audrey
(AS)
Babey Clifford
(B)
Eden Ngu Masama
(EN)
Guenou Etienne
(G)
Kwedi Nolna Sylvie
(KN)
Mbang Massom Douglas
(MM)
Melingui Bernard Fortune
(M)
Nga Elomo Nadia
(NE)
Mvetumbo Moïse
(M)
Nkembe Angeline
(N)
Ebo Krystel
(E)
Kuate Kuate Albert
(KK)
Choupa Michelline
(C)
Mbede Maggi
(M)
Donkeng Valerie
(D)
Kamgaing Nelly
(K)
Taguebue Jean-Voisin
(T)
Touha Yannick Achille
(TY)
Abomo Zang Estelle
(AZ)
Bakoa Rosette
(B)
Mimbouombela Leger Esperance
(ML)
Eleme Sabine
(E)
Eteme Marie Gabrielle
(EM)
Elouna Nkoa Thierry
(EN)
Ndzana Dieudonné
(N)
Bitti Christophe
(B)
Fotsing Olivier
(F)
Lani Boko Charlotte
(LB)
Mbonga Mathieu
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Njakou Sagang Ghislain Ulrich
(NS)
Onomo Innocent
(O)
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(EH)
Mboudi Kouang Daniel Desiré
(MK)
Eloundou Léon
(E)
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(K)
Mbassi Felix
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(B)
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(BB)
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(YE)
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(MM)
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(M)
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(NY)
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(E)
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(AN)
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(KD)
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(M)
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(MA)
Nguemafouo Doummene Rosine Berthe
(ND)
Mekone Amos
(M)
Konfor Blessing Ngwankfu
(KB)
Mimboe Jérome
(M)
Tiona Virginie
(T)
Beleck Roland
(B)
Zam Sairou
(Z)
Adibone Nicole
(A)
Biaback Jean Claude
(BJ)
Bessong Denis
(B)
Aminou Gilbert
(A)
Bille Bonga Jeremie Pagnol
(BB)
Fotso Monkap Aubin
(FM)
Hitekelek Epse Ngon Annie
(H)
Sebe Vitrice
(S)
Makon Leo
(M)
Sebe Vitrice
(S)
Ennah Marie
(E)
Paul Boyolo Mpie
(PB)
Metchoum Diane Viviane
(M)
Nzambe Celin
(N)
Dado Arnaud
(D)
Mbengang Milobert
(M)
Eyebi Marceline
(E)
Ngah Vanessa
(N)
Mballa Batonga Alice
(MB)
Ayouba Solange
(A)
Ebode Pierrette
(E)
Mamou Majino
(M)
Botomogne Bomba Marguerite
(BB)
Ngnet Salametou
(N)
Essengue Ngono Augustine Florence
(EN)
Odionoloba Charles Rolland
(OC)
Bisso Bernice
(B)
Balemaken Ingrid Suzy
(BI)
Mandoki A Bilong Marie Louise
(MAB)
Ndeng Ayouba Gertrude
(NA)
Ngon Josue
(N)
Aka Bony Roger
(AB)
Bah Kacou Michel
(B)
Bakayoko Dro
(B)
Baki Aimee Rolande
(BA)
Banga Marie-France Larissa
(B)
Bouzié Olivier
(B)
Brou Kan
(B)
Coulibaly Pan
(C)
Danho Serge
(D)
Deli Flavien
(D)
Dion Alphonse
(D)
Do Bi
(D)
Dohoun Armand
(D)
Edjeme William
(E)
Falé Cathérine
(F)
Gogoua Saulé Melissa
(GS)
Kesse Constant
(K)
Komena Auguste Eric
(KA)
Kouadio Christian
(K)
Kouame Abel Arkason
(KA)
Moh Raoul
(M)
Nguessan Marcelle Sandrine
(NM)
Siloué Bertine
(S)
Soua Nina
(S)
Yao Yapi Cyrille Prisca
(YY)
Ouassa Timothée
(O)
Kouakou Jacquemin
(K)
Balestre Eric
(B)
Beuscart Aurélie
(B)
Charpin Aurélie
(C)
D'elbee Marc
(D)
Font Hélène
(F)
Joshi Basant
(J)
Koskas Nicolas
(K)
Marcy Olivier
(M)
Occelli Estelle
(O)
Orne-Gliemann Joanna
(OG)
Poublan Julien
(P)
Vernoux Elodie
(V)
Bonnet Maryline
(B)
Chauvet Savine
(C)
Lounnas Manon
(L)
Breton Guillaume
(B)
Norval Pierre-Yves
(N)
Cassy Sheyla
(C)
Chambal Verna
(C)
Chiúle Valter
(C)
Chimbanje Supinho
(C)
Cumbe Saniata
(C)
Matsinhe Mércia
(M)
Khosa Celso
(K)
Mabote Nairo
(M)
Machava Salvador
(M)
Machonisse Emelva
(M)
Macuácua Verónica
(M)
Milice Denise
(M)
Ribeiro Jorge
(R)
Tivane Elcídio
(T)
Uetela Dorlim
(U)
Voss de Lima Yara
(VL)
Zandamela Américo
(Z)
Zita Alcina
(Z)
Manhiça Ivan
(M)
José Benedita
(J)
Rego Dalila
(R)
Buck W Chris
(BW)
Kasembe Kapoli
(K)
Massangaie Atália
(M)
Sitoe Assa
(S)
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(A)
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(M)
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(N)
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(S)
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(D)
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(M)
Amade Nilza
(A)
Chavela Manuela
(C)
Macheque Nomsa
(M)
Comé Salomão
(C)
Machava Eulália
(M)
Mucavele Narciso
(M)
Nhabanga Jacinto
(N)
Nicolau Marlene
(N)
Simbine Natércia
(S)
Uendela Lina
(U)
Juaio Micaela
(J)
Saíde Abiba
(S)
Macie Naira
(M)
Mondlane Fernando
(M)
Simango Stélio
(S)
Beyan Prince
(B)
Flomo Benjamin M
(F)
Jalloh Joseph Abubakarr
(JJ)
Kamara Ishmael
(K)
Koroma Monica G
(K)
Lamin Mohamed
(L)
Matata Lena
(M)
Mugisha Jacob Ross
(MJ)
Senesie Christiana M
(S)
S E S A Y Sheriff
(SESAY)
Tamba Kamara Egerton
(TK)
Mustapha Ayeshatu
(M)
Foray Lynda
(F)
Agondeze Sandra
(A)
Kobusingye Agnes
(K)
Nanfuka Mastula
(N)
Namulinda Faith
(N)
Wobudeya Eric
(W)
Arinaitwe Rinah
(A)
Kaitano Rodney
(K)
Kasujja Martin
(K)
Mwanga-Amumpaire Juliet
(MA)
Mwesigwa Evans
(M)
Natukunda Naome
(N)
Nuwamanya Simpson
(N)
Nyangoma Miria
(N)
Orikiriza Patrick
(O)
Tumwijukye Johnbosco
(T)
Turyashemererwa Esther
(T)
Dan Nyehangane
(D)
Ivan Mugisha
(I)
Biryeri Winnie
(B)
Naika George
(N)
Ongwara O Robert
(OO)
Najjuko Allen
(N)
Kayiira Augustine
(K)
Yairo Samuel
(Y)
Tumwebaze Immaculate
(T)
Nalwoga Goreth
(N)
Nsiyaleta Paul
(N)
Agaba Annet
(A)
Mpimbaza M Martin
(MM)
Akampurira Norbert
(A)
Tugumisirize Agatha
(T)
Ariyo Evans
(A)
Agaba Julius
(A)
Natukunda Yovita
(N)
Musazi Nelson
(M)
Musinguzi Edmund
(M)
Baluku Julius Brown
(BJ)
Sekadde Moorine
(S)
Turyahabwe Stavia
(T)
Chabala Chishala
(C)
Cuevas Luis
(C)
Delacourt Christophe
(D)
Graham Steve
(G)
Grzemska Malgorzata
(G)
Verkuijl Sabine
(V)
Hesseling Anneke
(H)
Maleche-Obimbo Elizabeth
(MO)
Nicol Mark
(N)
Mao Tan Eang
(M)
Informations de copyright
© 2024 World Health Organization.
Déclaration de conflit d'intérêts
All authors declare no competing interests.
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