@article{fdi:010091271,
  title = {{E}ffect 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},
  author = {{W}obudeya, {E}. and {N}anfuka, {M}. and {N}guyet, {M}htn and {T}aguebue, {J}. {V}. and {M}oh, {R}. and {B}reton, {G}. and {K}hosa, {C}. and {B}orand, {L}. and {M}wanga-{A}mumpaire, {J}. and {M}ustapha, {A}. and {N}olna, {S}. {K}. and {K}omena, {E}. and {M}ugisha, {J}. {R}. and {N}atukunda, {N}. and {D}im, {B}. and de {L}auzanne, {A}. and {C}umbe, {S}. and {B}alestre, {E}. and {P}oublan, {J}. and {L}ounnas, {M}anon and {N}gu, {E}. and {J}oshi, {B}. and {N}orval, {P}. {Y}. and {T}erquiem, {E}. {L}. and {T}uryahabwe, {S}. and {F}oray, {L}. and {S}idib{\'e}, {S}. and {A}lbert, {K}. {K}. and {M}anhi{\c{c}}a, {I}. and {S}ekadde, {M}. and {D}etjen, {A}. and {V}erkuijl, {S}. and {M}ao, {T}. {E}. and {O}rne-{G}liemann, {J}. and {B}onnet, {M}aryline and {M}arcy, {O}livier},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {C}hildhood 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. {D}ecentralising childhood {TB} diagnostics to district hospitals ({DH}) and primary health centres ({PHC}) could improve case detection. {M}ethods {W}e conducted an operational research study using a pre-post intervention cross-sectional study design in 12 {DH}s and 47 {PHC}s of 12 districts across {C}ambodia, {C}ameroon, {C} & ocirc;te d'{I}voire, {M}ozambique, {S}ierra {L}eone and {U}ganda. {T}he 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, {X}pert {U}ltra-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. {W}e collected aggregated and individual data. {W}e compared the proportion of tuberculosis detection in children and young adolescents <15 years pre-intervention (01 {A}ugust 2018-30 {N}ovember 2019) versus during intervention (07 {M}arch 2020-30 {S}eptember 2021), overall and by decentralisation approach. {T}his study is registered with {C}linical{T}rials.gov, {NCT}04038632. {F}indings {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). {I}n {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). {I}nterpretation {D}ecentralising and strengthening childhood {TB} diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant.},
  keywords = {{D}ecentralisation ; {C}hild ; {T}uberculosis ; {D}iagnosis ; {CAMBODGE} ; {CAMEROUN} ; {COTE} {D}'{IVOIRE} ; {MOZAMBIQUE} ; {SIERRA} {LEONE} ; {OUGANDA}},
  booktitle = {},
  journal = {{E}clinicalmedicine},
  volume = {70},
  numero = {},
  pages = {102527 [12 ]},
  year = {2024},
  DOI = {10.1016/j.eclinm.2024.102527},
  URL = {https://www.documentation.ird.fr/hor/fdi:010091271},
}