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 - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue EClinicalMedicine Année : 2024

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

Eric Wobudeya
  • Fonction : Auteur
Mastula Nanfuka
  • Fonction : Auteur
Jean-Voisin Taguebue
  • Fonction : Auteur
Raoul Moh
  • Fonction : Auteur
Guillaume Breton
  • Fonction : Auteur
Celso Khosa
  • Fonction : Auteur
Laurence Borand
  • Fonction : Auteur
Juliet Mwanga-Amumpaire
  • Fonction : Auteur
Ayeshatu Mustapha
  • Fonction : Auteur
Sylvie Kwedi Nolna
  • Fonction : Auteur
Eric Komena
  • Fonction : Auteur
Jacob Ross Mugisha
  • Fonction : Auteur
Naome Natukunda
  • Fonction : Auteur
Bunnet Dim
  • Fonction : Auteur
Agathe de Lauzanne
  • Fonction : Auteur
Saniata Cumbe
  • Fonction : Auteur
Eric Balestre
  • Fonction : Auteur
Manon Lounnas
  • Fonction : Auteur
Eden Ngu
  • Fonction : Auteur
Pierre-Yves Norval
  • Fonction : Auteur
Etienne Leroy Terquiem
  • Fonction : Auteur
Stavia Turyahabwe
  • Fonction : Auteur
Lynda Foray
  • Fonction : Auteur
Souleymane Sidibe
  • Fonction : Auteur
Kuate Kuate Albert
  • Fonction : Auteur
Ivan Manhica
  • Fonction : Auteur
Moorine Sekadde
  • Fonction : Auteur
Anne Detjen
  • Fonction : Auteur
Sabine Verkuijl
  • Fonction : Auteur
Tan Eang Mao
  • Fonction : Auteur
Maryline Bonnet
  • Fonction : Auteur

Résumé

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.
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hal-04622332 , version 1 (24-06-2024)

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Eric Wobudeya, Mastula Nanfuka, Minh Huyen Ton Nu Nguyet, Jean-Voisin Taguebue, Raoul Moh, et al.. 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. EClinicalMedicine, 2024, 70, pp.102527. ⟨10.1016/j.eclinm.2024.102527⟩. ⟨hal-04622332⟩

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