Publications by authors named "N Natukunda"
Cost-effectiveness and budget impact of decentralising childhood tuberculosis diagnosis in six high tuberculosis incidence countries: a mathematical modelling study.
EClinicalMedicine
April 2024
Article Synopsis
- The study examines the potential benefits of decentralizing childhood tuberculosis diagnosis to lower health system levels, aiming to improve case detection and reduce under-diagnosis.
- It compares two strategies: one focused on district hospitals and another on primary health centers, against the standard of care across six countries.
- The results indicate that while the district hospital approach may be more cost-effective in some settings, both strategies require significant budget increases for implementation, varying by country.
Effect of decentralising childhood tuberculosis diagnosis to primary health centre versus district hospital levels on disease detection in children from six high tuberculosis incidence countries: an operational research, pre-post intervention study.
EClinicalMedicine
April 2024
Article Synopsis
- Childhood tuberculosis (TB) is often underdiagnosed due to low awareness and limited access to necessary diagnostic tools in healthcare settings.
- An operational research study in several African and Asian countries tested a comprehensive diagnostic approach by decentralizing TB diagnostics to district hospitals and primary health centers for children under 15 years old.
- The intervention significantly increased TB detection rates, with diagnoses rising from 0.08% pre-intervention to 0.23% during the intervention, highlighting the effectiveness of decentralized health services.
Background: In people with human immunodeficiency virus (PWH), the World Health Organization-recommended tuberculosis (TB) 4-symptom screen (W4SS) targeting those who need molecular rapid testing may be suboptimal. We assessed the performance of different TB screening approaches in severely immunosuppressed PWH enrolled in the guided-treatment group of the STATIS trial (NCT02057796).
Methods: Ambulatory PWH with no overt evidence of TB and CD4 count <100 cells/µL were screened for TB prior to antiretroviral therapy (ART) initiation with W4SS, chest radiograph (CXR), urine lipoarabinomannan (LAM) test, and sputum Xpert MTB/RIF (Xpert).
Background: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality.
Methods: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis.
Knowledge, attitudes and practices on childhood TB among healthcare workers.
Int J Tuberc Lung Dis
March 2022
Increasing childhood TB case detection requires the deployment of diagnostic services at peripheral healthcare level. Capacity and readiness of healthcare workers (HCWs) are key to the delivery of innovative approaches. In 2019, HCWs from five district hospitals (DHs) and 20 primary healthcare centres (PHCs) in Cambodia, Cameroon, Cote d´Ivoire, Sierra Leone and Uganda completed a self-administered knowledge-attitudes-practices (KAP) questionnaire on childhood TB.
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