M Bonnet1, C Kyakwera2, N Kyomugasho3, D Atwine4, F Mugabe5, M Nansumba3, Y Boum Ii4, J Mwanga-Amumpaire4, J Kiwanuka2. 1. Epicentre, Mbarara, Uganda; Institut de Recherche pour le Développement, Unité Mixte Internationale 233 Translationnelles sur le VIH et les Maladies Infectieuses, Institut National de la Santé et de la Recherche Médicale Unité 1175, Montpellier, France. 2. Mbarara University of Science and Technology, Mbarara, Uganda. 3. Epicentre, Mbarara, Uganda. 4. Epicentre, Mbarara, Uganda; Mbarara University of Science and Technology, Mbarara, Uganda. 5. National Tuberculosis and Leprosy Program, Kampala, Uganda.
Abstract
SETTING: Screening and isoniazid preventive therapy (IPT) of child contacts of tuberculosis (TB) patients is poorly implemented in resource-limited countries, in part due to difficulties in TB diagnosis in children. OBJECTIVE: To assess the feasibility and yield of hospital-based screening and IPT in Uganda, and to evaluate the utility of symptom-based screening. DESIGN: Household child (age <5 years) contacts of adults with pulmonary TB were assessed for TB or latent tuberculous infection (LTBI). Children classified as 'LTBI' or 'uninfected' were prescribed IPT and followed for 9 months. Screening algorithms based on combinations of symptoms associated with TB were constructed post hoc, and their performance evaluated against a radiological-based reference standard. RESULTS: Of 281 contacts (median age 33 months), 44 (15.7%) started anti-tuberculosis treatment and 234 (83.3%) received IPT, 80.3% of whom completed a 6-month course. After adjustment for age and human immunodeficiency virus status, cough (aOR 4.10, 95%CI 1.39-12.11) and reduced playfulness (aOR 7.79, 95%CI 2.12-25.18) were associated with radiological TB. Screening based on cough or reduced playfulness had a sensitivity of 81.8% and a negative predictive value of 97.6%. CONCLUSION: Hospital-based screening appears to be feasible, and confirms the potential utility of symptom-based screening to select children for IPT and those for further investigations.
SETTING: Screening and isoniazid preventive therapy (IPT) of child contacts of tuberculosis (TB) patients is poorly implemented in resource-limited countries, in part due to difficulties in TB diagnosis in children. OBJECTIVE: To assess the feasibility and yield of hospital-based screening and IPT in Uganda, and to evaluate the utility of symptom-based screening. DESIGN: Household child (age <5 years) contacts of adults with pulmonary TB were assessed for TB or latent tuberculous infection (LTBI). Children classified as 'LTBI' or 'uninfected' were prescribed IPT and followed for 9 months. Screening algorithms based on combinations of symptoms associated with TB were constructed post hoc, and their performance evaluated against a radiological-based reference standard. RESULTS: Of 281 contacts (median age 33 months), 44 (15.7%) started anti-tuberculosis treatment and 234 (83.3%) received IPT, 80.3% of whom completed a 6-month course. After adjustment for age and human immunodeficiency virus status, cough (aOR 4.10, 95%CI 1.39-12.11) and reduced playfulness (aOR 7.79, 95%CI 2.12-25.18) were associated with radiological TB. Screening based on cough or reduced playfulness had a sensitivity of 81.8% and a negative predictive value of 97.6%. CONCLUSION: Hospital-based screening appears to be feasible, and confirms the potential utility of symptom-based screening to select children for IPT and those for further investigations.
Authors: Leonardo Martinez; Ye Shen; Andreas Handel; Srijita Chakraburty; Catherine M Stein; LaShaunda L Malone; W Henry Boom; Frederick D Quinn; Moses L Joloba; Christopher C Whalen; Sarah Zalwango Journal: Lancet Respir Med Date: 2017-12-19 Impact factor: 30.700
Authors: Elisa Farina; Carmen D'Amore; Laura Lancella; Elena Boccuzzi; Marta Luisa Ciofi Degli Atti; Antonino Reale; Paolo Rossi; Alberto Villani; Massimiliano Raponi; Umberto Raucci Journal: Ital J Pediatr Date: 2022-06-13 Impact factor: 3.288
Authors: S Zawedde-Muyanja; A Nakanwagi; J P Dongo; M P Sekadde; R Nyinoburyo; G Ssentongo; A K Detjen; F Mugabe; J Nakawesi; Y Karamagi; P Amuge; A Kekitiinwa; S M Graham Journal: Int J Tuberc Lung Dis Date: 2018-11-01 Impact factor: 2.373
Authors: Bryan Vonasek; Tara Ness; Yemisi Takwoingi; Alexander W Kay; Susanna S van Wyk; Lara Ouellette; Ben J Marais; Karen R Steingart; Anna M Mandalakas Journal: Cochrane Database Syst Rev Date: 2021-06-28