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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

dc.rights.licenseopenen_US
dc.contributor.authorWOBUDEYA, Eric
dc.contributor.authorNANFUKA, Mastula
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorTON NU NGUYET, Minh Huyen
dc.contributor.authorTAGUEBUE, Jean-Voisin
dc.contributor.authorMOH, Raoul
dc.contributor.authorBRETON, Guillaume
dc.contributor.authorKHOSA, Celso
dc.contributor.authorBORAND, Laurence
dc.contributor.authorMWANGA-AMUMPAIRE, Juliet
dc.contributor.authorMUSTAPHA, Ayeshatu
dc.contributor.authorNOLNA, Sylvie Kwedi
dc.contributor.authorKOMENA, Eric
dc.contributor.authorMUGISHA, Jacob Ross
dc.contributor.authorNATUKUNDA, Naome
dc.contributor.authorDIM, Bunnet
dc.contributor.authorDE LAUZANNE, Agathe
dc.contributor.authorCUMBE, Saniata
dc.contributor.authorBALESTRE, Eric
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorPOUBLAN, Julien
dc.contributor.authorLOUNNAS, Manon
dc.contributor.authorNGU, Eden
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorJOSHI, Basant
dc.contributor.authorNORVAL, Pierre-Yves
dc.contributor.authorTERQUIEM, Etienne Leroy
dc.contributor.authorTURYAHABWE, Stavia
dc.contributor.authorFORAY, Lynda
dc.contributor.authorSIDIBE, Souleymane
dc.contributor.authorALBERT, Kuate Kuate
dc.contributor.authorMANHICA, Ivan
dc.contributor.authorSEKADDE, Moorine
dc.contributor.authorDETJEN, Anne
dc.contributor.authorVERKUIJL, Sabine
dc.contributor.authorMAO, Tan Eang
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorORNE-GLIEMANN, Joanna
dc.contributor.authorBONNET, Maryline
hal.structure.identifierBordeaux population health [BPH]
hal.structure.identifierGlobal Health in the Global South [GHiGS]
dc.contributor.authorMARCY, Olivier
dc.contributor.authorGROUP, TB-Speed Decentralisation Study
dc.date.accessioned2024-06-24T13:41:45Z
dc.date.available2024-06-24T13:41:45Z
dc.date.issued2024-04-01
dc.identifier.issn2589-5370en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/200629
dc.description.abstractEnBACKGROUND: 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.
dc.language.isoENen_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subject.enChild
dc.subject.enDecentralisation
dc.subject.enDiagnosis
dc.subject.enTuberculosis
dc.title.enEffect 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
dc.title.alternativeEClinicalMedicineen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.eclinm.2024.102527en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed38685921en_US
bordeaux.journalEClinicalMedicineen_US
bordeaux.page102527en_US
bordeaux.volume70en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamGHIGS_BPHen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDInstitut de Recherche pour le Développementen_US
hal.identifierhal-04622332
hal.version1
hal.date.transferred2024-06-24T13:41:49Z
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
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