Evidence map›Paper›PMID 32467723›Full record

ArticleConflict and health2020

Improving pediatric TB diagnosis in North Kivu (DR Congo), focusing on a clinical algorithm including targeted Xpert MTB/RIF on gastric aspirates.

Daan Van Brusselen, Erica Simons, Tony Luendo, Delphine Habarugira, Jimmy Ngowa, Nadine Neema Mitutso, Zakari Moluh, Mieke Steenssens, Rachelle Seguin, Hilde Vochten and 3 more

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Article in Conflict and health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Daan Van Brusselen1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.
Erica Simons1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.
Tony LuendoBureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo.
Delphine HabarugiraBureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo.
Jimmy NgowaBureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo.
Nadine Neema MitutsoMédecins Sans Frontières (MSF), Mission RDC, 11 Avenue Massamba, Quartier Bassoko, Ngaliema, Kinshasa, Democratic Republic of the Congo.
Zakari Moluh1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.
Mieke Steenssens1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.
Rachelle Seguin1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.
Hilde Vochten1Médecins Sans Frontières (MSF), Operational Center Brussels, Rue de l'Arbre-Bénit 46, 1050 Brussels, Belgium.
Lucien NgaboBureau Central de Zone (de Santé), Masisi, Ministry of Health of North Kivu, Hôpital Régional de Référence de Masisi, Zone de Santé de Masisi, Nord-Kivu, Democratic Republic of the Congo.
Petros Isaakidis6Médecins Sans Frontières, Southern African Medical Unit (SAMU), Médecins Sans Frontières, Zurich House, 7th Floor, 70 Fox Street, Marshalltown, Johannesburg, South Africa.
Gabriella Ferlazzo6Médecins Sans Frontières, Southern African Medical Unit (SAMU), Médecins Sans Frontières, Zurich House, 7th Floor, 70 Fox Street, Marshalltown, Johannesburg, South Africa.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe incidence of tuberculosis (TB) in the Democratic Republic of the Congo (DRC) is 323/100,000. A context of civil conflict, internally displaced people and mining activities suggests a higher regional TB incidence in North Kivu. Médecins Sans Frontières (MSF) supports the General Reference Hospital of Masisi, North Kivu, covering a population of 520,000, with an elevated rate of pediatric malnutrition. In July 2017, an adapted MSF pediatric TB diagnostic algorithm, including Xpert MTB/RIF on gastric aspirates (GAs), was implemented. The aim of this study was to evaluate whether the introduction of this clinical pediatric TB diagnostic algorithm influenced the number of children started on TB treatment.

methodsWe performed a retrospective analysis of pediatric TB cases started on treatment in the inpatient therapeutic feeding centre (ITFC) and the pediatric ward. We compared data collected in the second half (July to December) of 2016 (before introduction of the new diagnostic algorithm) and the second half of 2017. For the outcome variables the difference between the two years was calculated by a Pearson Chi-square test.

resultsIn 2017, 94 GAs were performed, compared to none in 2016. Twelve percent (11/94) of samples were Xpert MTB/RIF positive. Sixty-eight children (2.9% of total exits) aged between 3 months and 15 years started TB treatment in 2017, compared to 19 (1.4% of total exits) in 2016 (p 0.002). The largest increase in pediatric TB diagnoses in 2017 occurred in patients with a negative Xpert MTB/RIF result, but clinically highly suggestive of TB according to the newly introduced diagnostic algorithm. Fifty-two (3.1%) children under five years old started treatment in 2017, as compared to 14 (1.3%) in 2016 (p 0.004). The increase was less pronounced and not statistically significant in older patients: sixteen children (2.6%) above 5 years old started TB treatment in 2017 as compared to five (1.3%) in 2016 (p 0.17).

conclusionAfter the introduction of an adapted clinical pediatric TB diagnostic algorithm, including Xpert MTB/RIF on gastric aspirates, we observed a significant increase in the number of children - especially under 5 years old - started on TB treatment, mostly on clinical grounds. Increased 'clinician awareness' of pediatric TB likely played an important role.

Indexed as

CongoDiagnosisGastric aspiratesOperational researchPediatricTuberculosis (TB)Xpert MTB/RIF

Identifiers

PMID32467723
PMCPMC7227188

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.