Browsing by Author "Bonnet, Maryline"

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    Development of tuberculosis treatment decision algorithms in children below 5 years hospitalised with severe acute malnutrition in Zambia and Uganda: a prospective diagnostic cohort study
    (Elsevier Ltd, 2024-07) Chabala, Chishala; Roucher, Clémentine; Ton Nu Nguyet, Minh Huyen; Babirekere, Esther; Inambao, Muleya; Businge, Gerald; Kapula, Chifunda; Shankalala, Perfect; Nduna, Bwendo; Mulenga, Veronica; Graham, Stephen; Wobudeya, Eric; Bonnet, Maryline; Marcy, Olivier; Marcy, Olivier; Serre, Angeline; Et.al
    In children with severe acute malnutrition (SAM) tuberculosis is common, challenging to diagnose, and often fatal. We developed tuberculosis treatment decision algorithms (TDAs) for children under the age of 5 years with SAM. In this prospective diagnostic study, we enrolled and followed up children aged <60 months hospitalised with SAM at three tertiary hospitals in Zambia and Uganda from 4 November 2019 to 20 June 2022. We included children aged 2–59 months with SAM as defined by WHO and hospitalised following the WHO clinical criteria. We excluded children with current or history of antituberculosis treatment within the preceding 3 months. They underwent tuberculosis symptom screening, clinical assessment, chest X-ray, abdominal ultrasound, Xpert MTB/RIF Ultra (Ultra) and culture on respiratory and stool samples with 6 months follow-up. Tuberculosis was retrospectively defined using the 2015 standard case definition for childhood tuberculosis. We used logistic regression to develop diagnostic prediction models for a one-step diagnosis and a two-step screening and diagnostic approaches. We derived scores from models using WHO-recommended thresholds for sensitivity and proposed TDAs. This study is registered with ClinicalTrials.gov, NCT04240990. Of 1906 children hospitalised with SAM during the study period, 1230 were screened, 1152 were eligible and 603 were enrolled. Of the 603 children enrolled–median age 15 (inter-quartile range (IQR): 11–20) months and 65 (11.0%) living with HIV–114 (18.9%) were diagnosed with tuberculosis, including 51 (8.5%) with microbiological confirmation and 104 (17.2%) initiated treatment at a median of 6(IQR: 2–10) days after inclusion. 108 children were retrospectively classified as having tuberculosis resulting in a prevalence of 17.9% (95% confidence intervals (CI): 15.1; 21.2). 75 (69.4%) children with tuberculosis reported cough of any duration, 32 (29.6%) cough ≥2 weeks and 11 (10.2%) tuberculosis contact history. 535 children had complete data and were included in the diagnostic prediction model. The one-step diagnostic model had 15 predictors, including Ultra, clinical, radiographic, and abdominal features, an area under the receiving operating curve (AUROC) of 0.910, and derived TDA sensitivity of 86.14% (95% CI: 78.07–91.56) and specificity of 80.88% (95% CI: 76.91–84.30). The two-step model had AUROCs of 0.750 and 0.912 for screening and diagnosis, respectively, and derived combined TDA sensitivity of 79.21% (95% CI: 70.30–85.98) and a specificity of 83.64% (95% CI: 79.87–86.82). Tuberculosis prevalence was high among hospitalised children with SAM, with atypical clinical features. TDAs achieved satisfactory diagnostic accuracy and could be used to improve diagnosis in this vulnerable group. Unitaid
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    Household costs incurred under community- and facility-based service-delivery models of tuberculosis preventive therapy for children: a survey in Cameroon and Uganda
    (Inishmore Laser Scientific Publishing Ltd, 2023-11) Mafirakureva, Nyashadzaishe; Mukherjee, Sushant; Tchounga, Boris; Atwine, Daniel; Tchakounte Youngui, Boris; Ssekyanzi, Bob; Okello, Richard; Leonie, Simo; Cohn, Jennifer; Casenghi, Martina; Vasiliu, Anca; Bonnet, Maryline; Dodd, Peter J
    Abstract Background Tuberculosis preventive treatment (TPT) in child household contacts is recommended by World Health Organization (WHO) but limited data has been reported on the costs experienced by households with children receiving TPT. Methods We evaluated the economic impact on households with children receiving TPT within a service-delivery model cluster-randomised controlled trial in Cameroon and Uganda. The intervention included community health worker-led home-based child-contact screening, TPT initiation and monitoring, and referral of children with presumptive tuberculosis or side effects, and was compared with each country’s facility-based standard of care (control). We used a retrospective cross-sectional survey adapted from the WHO Global task force on tuberculosis patient cost surveys. All costs were collected between February 2021 and March 2021 and are presented in 2021 US$. Results The median household costs estimated using the human capital approach were higher in the control arm ($62.96 [interquartile range, IQR; $19.78-239.74] in Cameroon and $35.95 [IQR; $29.03-91.26] in Uganda) compared to the intervention arm ($2.73 [IQR; $2.73-14.18] in Cameroon and $4.55 [IQR; $3.03-6.06] in Uganda). Using a threshold of 20% of annual household income, 15% (95%CI; 5-31%) of households in Cameroon and 14% (95%CI; 4-26%) in Uganda experienced catastrophic costs in the control compared to 3% (95%CI; 1- 8%) in Cameroon and 3% (95%CI; 1-8%) in Uganda in the intervention. Using the output-based approach to estimate income losses increased costs by 14-32% in the control and 13-19% in the intervention across the two countries. The proportion of participants experiencing any dissaving was higher in the control, 53% (95%CI; 36-71%) in Cameroon and 50% (95%CI; 31-69%) in Uganda, compared to 18% (95%CI; 10-29%) in Cameroon and 17% (95%CI; 8-28%) in Uganda in the intervention. Conclusions Households with child contacts initiated on TPT under a facility-based model incur significant costs. Community-based interventions help to reduce these costs but do not eliminate catastrophic expenditures. Registration https://clinicaltrials.gov/ct2/show/NCT03832023.
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    Tackling mortality due to childhood tuberculosis
    (Lancet public health, 2018) Godreuil, Sylvain; Marcy, Olivier; Wobudeya, Eric; Bonnet, Maryline; Solassol, Jérôme; Groc, Soraya; Abbate, Jessica L.; Le Gal, Frédéric; Gerber, Athenaïs; Tuaillon, Edouard
    Day, an opportunity to promote greater commitment and leadership in the fight against tuberculosis at all levels. It is particularly urgent to increase awareness and mobilisation on childhood tuberculosis because tuberculosis mortality is still unacceptably high in children. Indeed, there were 253 000 deaths among one million estimated cases in 2016, almost exclusively in young children who did not receive treatment.1,2 Affordable and child-friendly treatments are available, but childhood tuberculosis is often underdiagnosed: only 45% of all estimated paediatric tuberculosis cases were notified to the WHO in 2016.1 This situation is partly explained by the lack of adapted health-care structures and the low implementation of public health policy and tools for the detection and prevention of childhood tuberculosis.