Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial
Introduction Paediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children under age 5 years.Methods We compared the standard of care,...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2024-12-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/12/e016429.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850052697996132352 |
|---|---|
| author | Lise Denoeud-Ndam Rhoderick Machekano Anne Cecile Bissek Rose Masaba Millicent Ouma Saint Just Petnga Martina Casenghi Appolinaire Tiam Stephen Siamba Nicole Herrera Patrice Tchendjou Leonie Simo Boris Kevin Tchounga Gordon Odhiambo Okomo |
| author_facet | Lise Denoeud-Ndam Rhoderick Machekano Anne Cecile Bissek Rose Masaba Millicent Ouma Saint Just Petnga Martina Casenghi Appolinaire Tiam Stephen Siamba Nicole Herrera Patrice Tchendjou Leonie Simo Boris Kevin Tchounga Gordon Odhiambo Okomo |
| author_sort | Lise Denoeud-Ndam |
| collection | DOAJ |
| description | Introduction Paediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children under age 5 years.Methods We compared the standard of care, providing TB care in specific TB clinics (control phase), with the Catalysing Paediatric TB Innovations (CaP-TB) intervention, integrating TB services across all child health services (intervention phase). 12 clusters in Cameroon and Kenya transitioned from the standard of care to the intervention at randomly assigned times. Children with presumptive TB were enrolled after obtaining their parents’ consent and were followed throughout TB diagnostic procedures and treatment. Study outcomes included the rate of children with presumptive TB receiving TB investigations and that of children diagnosed with TB (the primary outcome was case detection), per thousand children under 5 years attending facilities. Generalised linear mixed Poisson models estimated the intervention’s effect as adjusted rate ratios (aRR) and associated 95% CIs. Ad hoc country-stratified analyses were conducted.Results During control and intervention phases, respectively, 121 909 and 109 614 children under 5 years attended paediatric entry points, 133 (1.1 per thousand) and 610 (5.6 per thousand) children with presumptive TB received TB investigations, and 79 and 74 were diagnosed with TB, corresponding to a case detection rate of 0.64 and 0.68 per thousand, respectively. CaP-TB significantly increased TB investigations in both countries overall (aRR=3.9, 95% CI 2.4 to 5.4), and in each. Overall, TB case detection was not statistically different between intervention and control (aRR 1.32, 95% CI 0.66 to 2.61, p=0.43). Country-stratified analysis revealed a 10-fold increase (aRR 9.75, 95% CI 1.04 to 91.84, p=0.046) in case detection with CaP-TB in Cameroon and no significant effect in Kenya (aRR 0.94, 95% CI 0.44 to 2.01, p=0.88).Conclusion CaP-TB increased TB investigations in both study countries and markedly enhanced TB case detection in one, underlining integrated TB services' potential to address paediatric TB underdiagnosis. |
| format | Article |
| id | doaj-art-a5c4502c26754806bbce52e3334c08bf |
| institution | DOAJ |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-a5c4502c26754806bbce52e3334c08bf2025-08-20T02:52:45ZengBMJ Publishing GroupBMJ Global Health2059-79082024-12-0191210.1136/bmjgh-2024-016429Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trialLise Denoeud-Ndam0Rhoderick Machekano1Anne Cecile Bissek2Rose Masaba3Millicent Ouma4Saint Just Petnga5Martina Casenghi6Appolinaire Tiam7Stephen Siamba8Nicole Herrera9Patrice Tchendjou10Leonie Simo11Boris Kevin Tchounga12Gordon Odhiambo Okomo13Elizabeth Glaser Pediatric AIDS Foundation, Geneva, SwitzerlandElizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA2Division of Health Operations Research, Cameroon Ministry of Public Health, CameroonElizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya4 Research, Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, KenyaPublic Health Evaluation and Research, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, CameroonElizabeth Glaser Pediatric AIDS Foundation, Geneva, Switzerland2 Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USAElizabeth Glaser Pediatric AIDS Foundation, Nairobi, KenyaElizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USAElizabeth Glaser Pediatric AIDS Foundation, Yaoundé, Cameroon8 Program, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, CameroonResearch, Elizabeth Glaser Pediatric AIDS Foundation, Yaoundé, CameroonMinistry of Health, Homa Bay, KenyaIntroduction Paediatric tuberculosis (TB) underdiagnosis is a critical concern. The INPUT stepped-wedge cluster-randomised trial assessed the impact of integrating child TB services into child healthcare on TB case detection among children under age 5 years.Methods We compared the standard of care, providing TB care in specific TB clinics (control phase), with the Catalysing Paediatric TB Innovations (CaP-TB) intervention, integrating TB services across all child health services (intervention phase). 12 clusters in Cameroon and Kenya transitioned from the standard of care to the intervention at randomly assigned times. Children with presumptive TB were enrolled after obtaining their parents’ consent and were followed throughout TB diagnostic procedures and treatment. Study outcomes included the rate of children with presumptive TB receiving TB investigations and that of children diagnosed with TB (the primary outcome was case detection), per thousand children under 5 years attending facilities. Generalised linear mixed Poisson models estimated the intervention’s effect as adjusted rate ratios (aRR) and associated 95% CIs. Ad hoc country-stratified analyses were conducted.Results During control and intervention phases, respectively, 121 909 and 109 614 children under 5 years attended paediatric entry points, 133 (1.1 per thousand) and 610 (5.6 per thousand) children with presumptive TB received TB investigations, and 79 and 74 were diagnosed with TB, corresponding to a case detection rate of 0.64 and 0.68 per thousand, respectively. CaP-TB significantly increased TB investigations in both countries overall (aRR=3.9, 95% CI 2.4 to 5.4), and in each. Overall, TB case detection was not statistically different between intervention and control (aRR 1.32, 95% CI 0.66 to 2.61, p=0.43). Country-stratified analysis revealed a 10-fold increase (aRR 9.75, 95% CI 1.04 to 91.84, p=0.046) in case detection with CaP-TB in Cameroon and no significant effect in Kenya (aRR 0.94, 95% CI 0.44 to 2.01, p=0.88).Conclusion CaP-TB increased TB investigations in both study countries and markedly enhanced TB case detection in one, underlining integrated TB services' potential to address paediatric TB underdiagnosis.https://gh.bmj.com/content/9/12/e016429.full |
| spellingShingle | Lise Denoeud-Ndam Rhoderick Machekano Anne Cecile Bissek Rose Masaba Millicent Ouma Saint Just Petnga Martina Casenghi Appolinaire Tiam Stephen Siamba Nicole Herrera Patrice Tchendjou Leonie Simo Boris Kevin Tchounga Gordon Odhiambo Okomo Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial BMJ Global Health |
| title | Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial |
| title_full | Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial |
| title_fullStr | Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial |
| title_full_unstemmed | Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial |
| title_short | Effect of integrating paediatric tuberculosis services into child healthcare services on case detection in Africa: the INPUT stepped-wedge cluster-randomised trial |
| title_sort | effect of integrating paediatric tuberculosis services into child healthcare services on case detection in africa the input stepped wedge cluster randomised trial |
| url | https://gh.bmj.com/content/9/12/e016429.full |
| work_keys_str_mv | AT lisedenoeudndam effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT rhoderickmachekano effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT annececilebissek effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT rosemasaba effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT millicentouma effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT saintjustpetnga effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT martinacasenghi effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT appolinairetiam effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT stephensiamba effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT nicoleherrera effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT patricetchendjou effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT leoniesimo effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT boriskevintchounga effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial AT gordonodhiambookomo effectofintegratingpaediatrictuberculosisservicesintochildhealthcareservicesoncasedetectioninafricatheinputsteppedwedgeclusterrandomisedtrial |