Effect of Integrating Pediatric Tuberculosis Services into Child Healthcare in Africa
Introduction
Pediatric tuberculosis (TB) is often underdiagnosed, which is a serious issue. The INPUT trial studied how combining TB services with child healthcare can improve TB detection in children under 5 years old.
Methods
We compared two approaches: the standard care, where TB services are provided only in specific clinics, and the Catalysing Paediatric TB Innovations (CaP-TB) approach, which integrates TB services into all child health services. In total, 12 clusters in Cameroon and Kenya switched from standard care to the new approach at different times. We enrolled children suspected of having TB with their parents’ consent and monitored them through diagnosis and treatment. We measured how many children received TB tests and how many were diagnosed with TB.
Results
During the study, 121,909 children attended the standard care phase, and 109,614 attended during the intervention phase. In the standard care phase, 133 children (1.1 per thousand) received TB tests, while 610 children (5.6 per thousand) did so during the intervention phase. The diagnosis rates were 0.64 and 0.68 per thousand, respectively. The CaP-TB approach significantly increased TB testing in both countries (adjusted rate ratio of 3.9). However, the overall TB diagnosis rate did not show a significant difference between the two approaches. Notably, in Cameroon, there was a tenfold increase in TB case detection with the new approach, while there was no significant change in Kenya.
Conclusion
The CaP-TB approach improved TB testing in both countries and significantly increased TB case detection in Cameroon. This highlights the importance of integrating TB services into child healthcare to better identify pediatric TB cases.
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