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Carter EJ, Mungai B, Njoroge T, Masese A, Szkwarko D, Angala P, Ronoh A, Owuor K, Masini E, Kamene M, Wekesa P. Finding the missing children for TB care and prevention in Kenya. Int J Tuberc Lung Dis 2022; 26:1144-1150. [PMID: 36447323 DOI: 10.5588/ijtld.22.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
SETTING: One hundred high TB burden facilities in nine counties in Kenya.OBJECTIVES: 1) To increase uptake of TB preventive therapy (TPT) among child contacts aged <5 years, and 2) to increase TB diagnosis in children aged <15 years presenting to health facilities for routine care.DESIGN: For objective 1, a clinic-based child contact management strategy incorporating transport/healthcare cost reimbursement, monitoring and evaluation tools, and healthcare worker education was utilized. For objective 2, community health screeners were established in pediatric outpatient departments to perform verbal screening, flagging symptomatic children for further evaluation.RESULTS: Over 15 months, identification of 8,060 individuals diagnosed with bacteriologically confirmed TB led to 2,022 child contacts. Of these, 1,848 (91%) were evaluated; 149 (8%) were diagnosed with TB disease, leaving 1,699 (92%) eligible for TPT; 1,613 (95%) initiated TPT and 1,335 (83%) completed TPT. In outpatient settings, 140,444 children were screened; 54,236 (39%) had at least two TB symptoms; 2,395 (4%) were diagnosed with TB diseaseCONCLUSION: Health system strengthening supporting a clinic-based child contact management program increased the number of children initiating TPT. Systematic screening in outpatient clinics can lead to increased TB case notifications; however, optimal screening tools and clearer diagnostic pathways for the evaluation of these children are needed.
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Affiliation(s)
- E J Carter
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - B Mungai
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - T Njoroge
- Centre for Health Solutions-Kenya, Nairobi, Kenya, Kenyatta National Hospital, Othaya, Kenya
| | - A Masese
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - D Szkwarko
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA, Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
| | - P Angala
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - A Ronoh
- Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program (DNTLDP), Nairobi, Kenya
| | - K Owuor
- Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - E Masini
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland, Stop TB Partnership, Geneva, Switzerland
| | - M Kamene
- Kenya Division of National Tuberculosis, Leprosy and Lung Disease Program (DNTLDP), Nairobi, Kenya
| | - P Wekesa
- Centre for Health Solutions-Kenya, Nairobi, Kenya
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Szkwarko D, Amisi JA, Peterson D, Burudi S, Angala P, Carter EJ. Using a mobile application to improve pediatric presumptive TB identification in western Kenya. Int J Tuberc Lung Dis 2021; 25:468-474. [PMID: 34049609 DOI: 10.5588/ijtld.20.0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Early recognition of TB symptoms in children is critical in order to link children to appropriate testing and treatment. Healthcare workers (HCWs) in high TB burden countries are often overburdened with competing clinical priorities, leading to incomplete presumptive TB screening. We assessed if implementing a community health volunteer (CHV) led presumptive pediatric TB mobile android application (PPTBMAPP) in pediatric outpatient, primary care clinics in western Kenya would be feasible, appropriate, and effective.METHODS: We used a mixed-methods participatory, iterative approach to design and implement the PPTBMAPP during a 6-month period. We compared the proportion of children identified in presumptive TB and active TB disease registers out of all patients before and after the implementation of the intervention.RESULTS: Of the 1787 children aged ≤15 years screened using the PPTBMAPP, 376 (21%) met the criteria for presumptive TB. There was a statistically significant increase in the proportion of children to all patients in the presumptive TB registers (97/908, 10.7% vs. 160/989, 16.2%; P = 0.0005), and a trend towards an increase in the proportion of children to all patients in the TB case register (17/117, 14.5% vs. 15/83, 18.1%; P = 0.5). HCWs interviewed commented that the application sped up the presumptive TB screening process.CONCLUSION: Our CHV-led mobile screening intervention significantly increased presumptive TB notification. HCWs reported that the mobile screening intervention was feasible, appropriate, and effective.
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Affiliation(s)
- D Szkwarko
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
| | - J A Amisi
- Department of Family Medicine, College of Health Sciences, Moi University, Eldoret, Kenya, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - D Peterson
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI
| | - S Burudi
- Webuye County Hospital, Webuye, Kenya
| | - P Angala
- Center for Health Solutions-Kenya, Nairobi, Kenya
| | - E J Carter
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Szkwarko D, Owiti P, Buziba N, Bigelow C, Eaton CB, Carter EJ. Implementation of an active, clinic-based child tuberculosis contact management strategy in western Kenya. Public Health Action 2018; 8:91-94. [PMID: 29946526 DOI: 10.5588/pha.17.0119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/18/2018] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis (TB) is a leading cause of childhood mortality. Isoniazid preventive therapy significantly reduces progression to TB disease. The World Health Organization recommends that high TB burden countries conduct child contact management (CCM) to identify exposed child contacts aged <5 years for screening and appropriate treatment. An active, clinic-based CCM strategy incorporating transport/screening reimbursement, monitoring and evaluation tools, and health care worker education was implemented in western Kenya. Among 169 identified child contacts aged <5 years, 146 (86%) underwent successful screening, of whom 43 (29%) were diagnosed with active TB. We describe our CCM strategy and its potential for enhancing screening and treatment efforts.
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Affiliation(s)
- D Szkwarko
- 1 Department of Family Medicine and Community Health, The University of Massachusetts Medical School, Worcester, Massachusetts, USA.,Department of Family Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - P Owiti
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,International Union Against Tuberculosis and Lung Disease, Paris, France
| | - N Buziba
- Department of Hematology, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - C Bigelow
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - C B Eaton
- Department of Family Medicine, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.,Department of Epidemiology, School of Public Health, Brown University, Rhode Island, USA
| | - E J Carter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Department of Medicine, Warren Alpert Medical School, Brown University, Rhode Island, USA
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Szkwarko D, Mercer T, Kimani S, Braitstein P, Buziba N, Carter EJ. Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya. Public Health Action 2016; 6:142-6. [PMID: 27358809 DOI: 10.5588/pha.16.0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Street-connected youth and young adults (SCY) suffer a myriad of health problems. In Kenya, SCY are at high risk for tuberculosis (TB) due to their congregate living situations. TB screening is not routinely implemented in SCY and there has been no published literature on the burden of TB in SCY in western Kenya. PROGRAM DESCRIPTION In 2011, the AMPATH TB Program, an experienced TB screening program, partnered with the Tumaini Center, a trusted street youth organization, to conduct intensified case finding (ICF) for pulmonary TB among SCY. Our program aimed to investigate the numbers of SCY who reported symptoms and those diagnosed with smear-positive pulmonary TB, and link SCY with TB to treatment. RESULTS Of 116 SCY who were screened, 114 (98%) had a positive questionnaire; 104 (90%) provided a spot sputum sample, 39 (34%) provided a morning sputum sample, and 111 (97%) reported cough of >2 weeks. One street youth tested smear-positive for TB and was treated through to cure. CONCLUSIONS Implementing TB ICF is feasible in low-resource settings through unique collaborations between health care programs and community-based organizations. In addition to identifying smear-positive TB, our program uncovered a high burden of respiratory symptoms among SCY in Eldoret, Kenya.
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Affiliation(s)
- D Szkwarko
- Tumaini Center, Eldoret, Kenya ; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - T Mercer
- Tumaini Center, Eldoret, Kenya ; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - P Braitstein
- Tumaini Center, Eldoret, Kenya ; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - N Buziba
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya
| | - E J Carter
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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Szkwarko D, Ogaro F, Owiti P, Carter EJ. Implementing a tuberculosis child contact register to quantify children at risk for tuberculosis and HIV in Eldoret, Kenya. Public Health Action 2015; 3:209-13. [PMID: 26393031 DOI: 10.5588/pha.13.0018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/01/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) clinic in Eldoret, Kenya. OBJECTIVE To identify TB exposed children through the implementation of a child contact register (CCR). To assess the demographics of children exposed to TB and the potential for initiation of isoniazid preventive therapy (IPT) in this cohort. METHODS A CCR was implemented in routine care with health care workers querying index cases regarding child contacts. Data were retrospectively analyzed. RESULTS In 12 months, the CCR revealed 580 children exposed to TB. Of these, 58% were exposed to smear-positive TB and 30% were aged <5 years. Of those exposed to smear-positive TB, 15% may have qualified for IPT initiation. Only 6 (1%) child contacts were screened for TB disease. More than 50% of the children with human immunodeficiency virus (HIV) positive mothers had not been HIV tested. CONCLUSION Implementation of a CCR is a possible first step in child contact identification and management, which requires minimal resources and identifies children at risk for TB and HIV. Child contact screening and IPT initiation remain a challenge, and additional strategies are urgently needed.
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Affiliation(s)
- D Szkwarko
- The Memorial Hospital of Rhode Island Brown Family Medicine Residency Program, Pawtucket, Rhode Island, USA
| | - F Ogaro
- Moi University School of Medicine, Eldoret, Kenya
| | - P Owiti
- United States Agency for International Development- Academic Model Providing Access to Healthcare (USAID/AMPATH) Partnership, Eldoret, Kenya
| | - E J Carter
- United States Agency for International Development- Academic Model Providing Access to Healthcare (USAID/AMPATH) Partnership, Eldoret, Kenya ; Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, USA
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Kosgei RJ, Szkwarko D, Callens S, Gichangi P, Temmerman M, Kihara AB, Sitienei JJ, Cheserem EJ, Ndavi PM, Reid AJ, Carter EJ. Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya. Public Health Action 2015; 3:294-8. [PMID: 26393049 DOI: 10.5588/pha.13.0073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/27/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ≥2 weeks' duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya. DESIGN Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya. RESULTS Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26-35) and 26 years (IQR 24-31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at enrolment was 377 cells/μl (IQR 244-530) for HIV-infected women. One non-HIV-infected patient was sputum-positive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants. CONCLUSION This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a routine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.
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Affiliation(s)
- R J Kosgei
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - D Szkwarko
- AMPATH, Eldoret, Kenya ; The Memorial Hospital of Rhode Island Brown Family Medicine Residency Program, Pawtucket, Rhode Island, USA
| | - S Callens
- University of Ghent School of Medicine, Ghent, Belgium
| | - P Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - M Temmerman
- University of Ghent School of Medicine, Ghent, Belgium
| | - A-B Kihara
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J J Sitienei
- AMPATH, Eldoret, Kenya ; Moi University School of Public Health, Eldoret, Kenya
| | - E J Cheserem
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - P M Ndavi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - A J Reid
- Operational Research Unit, Médecins Sans Frontières Operational Centre Brussels, Luxembourg
| | - E J Carter
- AMPATH, Eldoret, Kenya ; Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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