Strategies to increase childhood tuberculosis case detection at the primary health care level: Lessons from an active case finding study in Zambia.
Strategies to increase childhood tuberculosis case detection at the primary health care level: Lessons from an active case finding study in Zambia.
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DOI：
10.1371/journal.pone.0288643
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发表时间：
2023
期刊：
影响因子：
3.7
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中科院分区：
文献类型：
--
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在结核病高负担环境中，据估计，儿童应占结核病总报告的10-20%，然而，目前赞比亚结核病总报告中只有6-8%是儿童。我们评估了在初级卫生保健机构实施多组分战略，系统地针对儿童结核病诊断级联的每一步的障碍，是否可以提高儿童结核病病例的检出率。我们在赞比亚卢萨卡的两个干预和两个控制1级医院进行了一项受控的中断时间序列分析，以比较儿童结核病病例报告之前（2018年1月至2019年12月）和实施期间（2020年1月至2021年9月）。在每一个干预设施，我们实施了一个多方面的战略，包括：（1）儿童结核病和胸部X光片判读方面的能力发展，（2）结核病宣传和创造需求活动，（3）建立快速结核病服务，（4）加强家庭接触者追踪，（5）通过加强儿童样本采集，改善结核病筛查数字化胸部X射线和结核病诊断Xpert MTB/Rif Ultra的可及性。在研究期间，在两个干预设施筛查的5，150名15岁以下儿童中，有503名（9.8%）被诊断患有结核病。其中，433例（86.1%）是通过基于设施的活动确定的（10.5%的收率），70例（13.9%）是通过家庭接触者追踪确定的（6.9%的收率）。总的来说，446名儿童（88.7%）结核病儿童被临床诊断。在实施多成分战略后，儿童占结核病总报告的比例立即改变了+1.5%（95%CI：-3.5，6.6）和-4.4%（95%CI：-7.5，1.4）（差异6.0% [95%CI：-0.7，12.7]），p = 0.08）;儿童期通知的比例增加0.9%（95%CI：-0.7，2.5%），与实施前的趋势相比，对照部位（-95%CI：-1.8，-0.6）（每季度差异2.1% [95%CI：0.1，4.2]，p = 0.046）;这意味着在干预和控制地点分别增加了352例和减少了85例儿童结核病报告，与实施前相比。一套标准化的策略，以改善儿童结核病检测在初级卫生保健设施是可行的，并与持续改善儿童结核病的通知。
In high TB burden settings, it is estimated that 10–20% of total notifications should be children, however, currently only 6–8% of the total TB notifications in Zambia are children. We assessed whether the implementation of a multicomponent strategy, at primary healthcare facilities, that systematically targets barriers at each step of the childhood TB diagnostic cascade can increase childhood TB case detection. We conducted a controlled, interrupted time series analysis to compare childhood TB case notifications before (January 2018—December 2019), and during implementation (January 2020—September 2021) in two intervention and two control Level 1 hospitals in Lusaka, Zambia. At each of the intervention facilities, we implemented a multicomponent strategy constituting: (1) capacity development on childhood TB and interpretation of chest x-ray, (2) TB awareness-raising and demand creation activities, (3) setting up fast track TB services, (4) strengthening of household contact tracing, and (5) improving access to digital chest X-ray for TB screening and Xpert MTB/Rif Ultra for TB diagnosis, through strengthening sample collection in children. Among 5,150 children < 15 years screened at the two intervention facilities during the study period, 503 (9.8% yield) were diagnosed with TB. Of these, 433 (86.1%) were identified through facility-based activities (10.5% yield) and 70 (13.9%) were identified through household contact tracing (6.9% yield). Overall, 446 children (88.7%) children with TB were clinically diagnosed. Following implementation of the multicomponent strategy, the proportion children contributed to total TB notifications immediately changed by +1.5% (95%CI: -3.5, 6.6) and -4.4% (95%CI: -7.5, 1.4) at the intervention and control sites, respectively (difference 6.0% [95%CI: -0.7, 12.7]), p = 0.08); the proportion of childhood notifications increased 0.9% (95%CI: -0.7, 2.5%) each quarter at the intervention sites relative to pre-implementation trends, while declining 1.2% (-95%CI: -1.8, -0.6) at the control sites (difference 2.1% [95%CI: 0.1, 4.2] per quarter between, p = 0.046); this translated into 352 additional and 85 fewer childhood TB notifications at the intervention and control sites, respectively, compared to the pre-implementation period. A standardized package of strategies to improve childhood TB detection at primary healthcare facilities was feasible to implement and was associated with a sustained improvement in childhood TB notifications.
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DOI：
10.5588/ijtld.21.0317
发表时间：
2022-03-01
影响因子：
4
作者：
Joshi, B.;Font, H.;Wobudeya, E.;Nanfuka, M.;Kobusingye, A.;Mwanga-Amumpaire, J.;Natukunda, N.;Turyahabwe, S.;Borand, L.;Mao, T. E.;Dim, B.;Ferhi, R.;Moh, R.;Kouakou, J.;Bony, R. Aka;Breton, G.;Mustapha, A.;Matata, L.;Foray, L.;Detjen, A.;Verkuijl, S.;Sekadde, M.;Khosa, C.;Mbassa, V;Taguebue, J-, V;Nolna, S. Kwedi;Bonnet, M.;Marcy, O.;Orne-Gliemann, J.
通讯作者：
Orne-Gliemann, J.
影响因子：
15.8
作者：
Hanrahan, Colleen F.;Nonyane, Bareng A. S.;Dowdy, David W.
通讯作者：
Dowdy, David W.
影响因子：
168.9
作者：
Reuter, Anja;Hughes, Jennifer;Furin, Jennifer
通讯作者：
Furin, Jennifer
DOI：
10.1016/j.jctube.2017.10.003
发表时间：
2017-12-01
影响因子：
2
作者：
Mwangwa, Florence;Chamie, Gabriel;Marquez, Carina
通讯作者：
Marquez, Carina
影响因子：
4.5
作者：
Paul, Sukanta;Akter, Rahima;Sarker, Malabika
通讯作者：
Sarker, Malabika