Publications by authors named "Walter Mchembere"
Background: People with human immunodeficiency virus (HIV) smoke at much higher rates than the general population, resulting in higher risk for tobacco-related morbidity and mortality. The efficacy of smoking cessation interventions among people with HIV in lower-middle-income countries remains unclear.
Methods: We conducted a randomized, 2 × 2 factorial design trial based in Nairobi, Kenya, to evaluate the efficacy of bupropion versus placebo, and a culturally tailored behavioral cessation therapy, called Positively Smoke Free (PSF), versus standard of care for people with HIV who smoke.
The diagnosis of paediatric pulmonary tuberculosis is difficult, especially in young infants who cannot expectorate sputum spontaneously. Breath testing has shown promise in diagnosing respiratory tract infections, but data on paediatric tuberculosis are limited. We performed a prospective cross-sectional study in Kenya in children younger than five years with symptoms of tuberculosis.
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- Diagnosing tuberculosis (TB) in children under 5 is difficult due to low bacterial levels and overlapping symptoms with other diseases, leading researchers to use machine learning for better prediction models.
- Eleven machine learning models were tested on data from young children in Kenya to improve the accuracy of TB microbial confirmation using easily obtainable clinical, demographic, and radiologic factors.
- The study found that models were effective with AUROC scores between 0.83 and 0.90, and certain factors like household TB contact and chest x-ray results significantly influenced prediction outcomes, potentially aiding clinical decisions and research on TB in young children.
Background: Pediatric tuberculosis (TB) remains a critical public health concern, yet bacteriologic confirmation of TB in children is challenging. Clinical, demographic, and radiological factors associated with a positive specimen in young children (≤5 years) are poorly understood.
Methods: We conducted a prospective cohort study of young children with presumptive TB and examined clinical, demographic, and radiologic factors associated with invasive and noninvasive specimen collection techniques (gastric aspirate, induced sputum, nasopharyngeal aspirate, stool, and string test); up to 2 samples were taken per child, per technique.
Background: Tuberculosis (TB) is a leading cause of illness and death in children globally. Improved bacteriologic and clinical diagnostic approaches in children are urgently needed.
Methods: In a prospective cohort study, a consecutive series of young (<5 years) children presenting with symptoms suggestive of TB and parenchymal abnormality on chest radiograph in inpatient and outpatient settings in Kisumu County, Kenya from October 2013 to August 2015 were evaluated at baseline and over 6 months.
Article Synopsis
- There is currently no definitive microbiological gold standard for diagnosing childhood tuberculosis (TB) due to the disease's low bacterial count and difficulties in obtaining samples from young children.
- New World Health Organization guidelines suggest using rapid molecular tests and alternative sampling methods, but their adoption in areas with high TB prevalence is still quite low.
- This review examines both historical and modern diagnostic techniques, addresses existing challenges in improving diagnostic accuracy, and highlights research areas needing attention to enhance TB diagnosis in children.
Background: HIV testing efficiency could be improved by focusing on high yield populations and identifying types of health facilities where people with undiagnosed HIV infection are more likely to attend.
Methods: A retrospective cohort analysis of data collected during an integrated TB/HIV active case-finding intervention in Western Kenya. Data were analyzed from health facilities' registers on individuals who reported TB-suggestive symptoms between 1 July and 31 December 2018 and who had an HIV test result within one month following symptom screening.
Importance: Criterion-standard specimens for tuberculosis diagnosis in young children, gastric aspirate (GA) and induced sputum, are invasive and rarely collected in resource-limited settings. A far less invasive approach to tuberculosis diagnostic testing in children younger than 5 years as sensitive as current reference standards is important to identify.
Objective: To characterize the sensitivity of preferably minimally invasive specimen and assay combinations relative to maximum observed yield from all specimens and assays combined.
Objective: To evaluate the utility of a broad and nonspecific symptom screen for identifying people with undiagnosed HIV infection.
Design: Secondary analysis of operational data collected during implementation of a cluster-randomized trial for tuberculosis case detection.
Methods: As part of the trial, adults reporting cough, fever, night sweats, weight loss, or difficulty breathing for any duration in the past month were identified in health facilities and community-based mobile screening units in western Kenya.
Background: The two issues mostly affecting the success of tuberculosis (TB) control programmes are delay in presentation and non-adherence to treatment. It is important to understand the factors that contribute to these issues, particularly in resource limited settings, where rates of tuberculosis are high. The objective of this study is to assess health-seeking behaviour and health care experiences among persons with pulmonary tuberculosis, and identify the reasons patients might not complete their treatment.
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