Impact of the Stool-Based Xpert Test on Childhood Tuberculosis Diagnosis in Selected States in Nigeria
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Setting
2.3. Intervention
2.4. Study Population and Specimen Collection
2.5. Procedure for Stool Processing
2.6. Data Variables, Sources, and Collection
2.7. Statistical Analysis
2.8. Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Burusie, A.; Enquesilassie, F.; Salazar-Austin, N.; Addissie, A. Epidemiology of childhood tuberculosis and predictors of death among children on tuberculosis treatment in central Ethiopia: An extended Cox model challenged survival analysis. BMC Public Health 2023, 23, 1287. [Google Scholar] [CrossRef]
- Maphalle, L.N.F.; Michniak-Kohn, B.B.; Ogunrombi, M.O.; Adeleke, O.A. Pediatric Tuberculosis Management: A Global Challenge or Breakthrough? Children 2022, 9, 1120. [Google Scholar] [CrossRef] [PubMed]
- De Haas, P.; Yenew, B.; Mengesha, E.; Slyzkyi, A.; Gashu, Z.; Lounnas, M.; Tesfaye, E.; Bedru, A.; Tiemersma, E.; Kremer, K.; et al. The Simple One-Step (SOS) Stool Processing Method for Use with the Xpert MTB/RIF Assay for a Child-Friendly Diagnosis of Tuberculosis Closer to the Point of Care. J. Clin. Microbiol. 2021, 59, e0040621. [Google Scholar] [CrossRef]
- Newton, S.M.; Brent, A.J.; Anderson, S.; Whittaker, E.; Kampmann, B. Pediatric tuberculosis. Lancet Infect. Dis. 2008, 8, 498–510. [Google Scholar] [CrossRef]
- Swaminathan, S.; Rekha, B. Pediatric tuberculosis: Global overview and challenges. Clin. Infect. Dis. 2010, 50 (Suppl. 3), S184–S194. [Google Scholar] [CrossRef] [PubMed]
- WHO. WHO Operational Handbook on Tuberculosis. Module 3: Diagnosis: Rapid Diagnostics for Tuberculosis Detection; World Health Organization: Geneva, Switzerland, 2020; Available online: https://apps.who.int/iris/bitstream/handle/10665/332864/9789240007284-eng.pdf?sequence=1&isAllowed=y (accessed on 27 December 2023).
- Chipinduro, M.; Mateveke, K.; Makamure, B.; Ferrand, R.A.; Gomo, E. Stool Xpert MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe. Int. J. Tuberc. Lung Dis. 2017, 21, 161–166. [Google Scholar] [CrossRef]
- Marais, B.J. Childhood Tuberculosis: Epidemiology and Natural History of Disease. Indian J. Pediatr. 2011, 78, 321–327. [Google Scholar] [CrossRef]
- Sant’Anna, C.C.; Maria de Fátima, B.; Aurílio, R.B. Diagnosis of Tuberculosis among Children and Adolescents. In Mycobacterium: Research and Development; IntechOpen: London, UK, 2017; Available online: https://www.intechopen.com/books/5853 (accessed on 18 December 2023).
- Amado, C.A.; Ferrer, D.J.; Agüero, R.; Ocejo-Vinyals, J.G. Clinical, Radiological and Immunological Features in Children with Pulmonary Tuberculosis: A Review. J. Mycobac. Dis. 2014, 4, 159. [Google Scholar] [CrossRef]
- Marais, B.J.; Obihara, C.C.; Warren, R.M.; Schaaf, H.S.; Gie, R.P.; Donald, P.R. The burden of childhood tuberculosis: A public health perspective [Review Article]. Int. J. Tuberc. Lung Dis. 2005, 9, 1305–1313. [Google Scholar]
- WHO. WHO Consolidated Guidelines on Tuberculosis. Module 3: Diagnosis: Rapid Diagnostics for Tuberculosis Detection; World Health Organization: Geneva, Switzerland, 2021. [Google Scholar]
- De Haas, P.; Yenew, B.; Diriba, G.; Amare, M.; Slyzkyi, A.; Demissie, Y.; Sherefdin, B.; Bedru, A. The Simple One-step stool processing method for detection of pulmonary tuberculosis: A study protocol to assess the robustness, stool storage conditions and sampling strategy for global implementation and scale-up. PLoS ONE 2022, 17, e0264103. [Google Scholar] [CrossRef]
- Mafirakureva, N.; Klinkenberg, E.; Spruijt, I.; Levy, J.; Shaweno, D.; de Haas, P.; Kaswandani, N.; Bedru, A.; Triasih, R.; Gebremichael, M.; et al. Xpert Ultra stool testing to diagnose tuberculosis in children in Ethiopia and Indonesia: A model-based cost-effectiveness analysis. BMJ Open 2022, 12, e058388. [Google Scholar] [CrossRef] [PubMed]
- Gebre, M.; Cameron, L.H.; Tadesse, G.; Woldeamanuel, Y.; Wassie, L. Variable diagnostic performance of stool Xpert in pediatric tuberculosis: A systematic review and meta-analysis. Open Forum Infect. Dis. 2021, 8, ofaa627. [Google Scholar] [CrossRef] [PubMed]
- WHO. Roadmap towards Ending TB in Children and Adolescents, 3rd ed.; World Health Organization: Geneva, Switzerland, 2023. [Google Scholar]
- Babo, Y.; Seremolo, B.; Bogale, M.; Bedru, A.; Wabe, Y.; Churako, H.; Bilat, A.; Degaga, T.; de Haas, P.; Tiemersma, E.; et al. Comparison of Xpert MTB/RIF Ultra Results of Stool and Sputum in Children with Presumptive Tuberculosis in Southern Ethiopia. Trop. Med. Infect. Dis. 2023, 8, 350. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Yenew, B.; De Haas, P.; Diriba, G.; Kebede, A.; Sherefdin, B.; Demissie, Y.; Bedru, A.; Sahile, M.; Mengesha, E.; Dememew, Z.G.; et al. Optimization of the Simple One-Step Stool Processing Method to Diagnose Tuberculosis: Evaluation of Robustness and Stool Transport Conditions for Global Implementation. Microbiol. Spectr. 2023, 11, e01171-23. [Google Scholar] [CrossRef] [PubMed]
- National Guidelines for the Management of TB/HIV Co-Infection in Nigeria, 3rd ed.; Department of Public Health, Federal Ministry of Health, Federal Republic of Nigeria: Abuja, Nigeria, 2020.
- WHO. WHO Operational Handbook on Tuberculosis. Module 5: Management of Tuberculosis in Children and Adolescents; World Health Organization: Geneva, Switzerland, 2000. [Google Scholar]
- Guidance for National Tuberculosis Programs on the Management of Tuberculosis in Children, 2nd ed.; World Health Organization: Geneva, Switzerland, 2014.
- Peer, V.; Schwartz, N.; Green, M.S. Gender differences in tuberculosis incidence rates—A pooled analysis of data from seven high-income countries by age group and time period. Front. Public Health 2023, 10, 997025. [Google Scholar] [CrossRef] [PubMed]
- Dubale, M.; Tadesse, M.; Berhane, M.; Mekonnen, M.; Abebe, G. Stool-based Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children at a teaching and referral hospital in Southwest Ethiopia. PLoS ONE 2022, 17, e0267661. [Google Scholar] [CrossRef]
- Ogbudebe, C.L.; Adepoju, V.; Ekerete-Udofia, C.; Abu, E.; Egesemba, G.; Chukwueme, N.; Gidado, M. Childhood Tuberculosis in Nigeria: Disease Presentation and Treatment Outcomes. Health Serv. Insights 2018, 11, 1178632918757490. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Kabir, S.; Rahman, S.M.; Ahmed, S.; Islam, M.S.; Banu, R.S.; Shewade, H.D.; Thekkur, P.; Anwar, S.; Banu, N.A.; Nasrin, R.; et al. Xpert Ultra Assay on Stool to Diagnose Pulmonary Tuberculosis in Children. Clin. Infect. Dis. 2021, 73, 226–234. [Google Scholar] [CrossRef] [PubMed]
- Andriyoko, B.; Janiar, H.; Kusumadewi, H.; Klinkenberg, E.; De Haas, P.; Tiemersma, E. Simple stool processing method for the diagnosis of pulmonary tuberculosis using GeneXpert MTB/RIF. Eur. Respir. J. 2019, 53, 1801832. [Google Scholar] [CrossRef]
Variable | 0–4 Years n (%) | 5–14 Years n (%) | Total |
---|---|---|---|
Presumptive TB sent for sputum evaluation | 115,271 (29.5) | 275,946 (70.5) | 391,217 |
Presumptive cases evaluated for TB | 104,809 (29.0) | 256,643 (71.0) | 361,452 |
Total TB cases diagnosed | 3108 (24.7) | 9485 (75.3) | 12,593 |
Diagnosed with DS-TB | 3093 (24.7) | 9438 (75.3) | 12,531 |
Diagnosed with DR-TB | 15 (24.2) | 47 (75.8) | 62 |
Total TB patients started on treatment | 2948 (24.6) | 9042 (75.4) | 11,990 |
DS-TB patients started on treatment | 2939 (24.6) | 9021 (75.4) | 11,960 |
DR-TB patients started on treatment | 9 (30.0) | 21 (70.0) | 30 |
Presumptive evaluation rate | 90.9% | 93.0% | 92.4% |
TB yield | 3.0% | 3.7% | 3.5% |
Treatment enrollment rate | 94.9% | 95.3% | 95.2% |
Variable | 0–4 Years n (%) | 5–14 Years n (%) | Total |
---|---|---|---|
Presumptive TB sent for stool evaluation | 31,131 (59.7) | 20,986 (40.3) | 52,117 |
Presumptive cases evaluated for TB | 30,455 (60.0) | 20,319 (40.0) | 50,774 |
Total diagnosed TB cases | 1414 (58.0) | 1026 (42.0) | 2440 |
Diagnosed with DS-TB | 1402 (58.1) | 1012 (41.9) | 2414 |
Diagnosed with DR TB | 12 (46.2) | 14 (53.8) | 26 |
Total TB patients started on treatment | 1351 (58.6) | 956 (41.4) | 2307 |
DS-TB patients started on treatment | 1341 (58.6) | 946 (41.4) | 2287 |
DR-TB patients started on treatment | 10 (50.0) | 10 (50.0) | 20 |
Presumptive evaluation rate | 97.8% | 96.8% | 97.4% |
TB yield | 4.6% | 5.0% | 4.8% |
Treatment enrollment rate | 95.5% | 93.4% | 94.6% |
Variable | Sub-Category | Male | Female | Total | ||
---|---|---|---|---|---|---|
0–4 Years n (%) | 5–14 Years n (%) | 0–4 Years n (%) | 5–14 Years n (%) | |||
Stool sample referred | 16,504 (31.7) | 10,539 (20.2) | 14,627 (28.1) | 10,447 (28.1) | 52,117 | |
Stool sample evaluated for TB | 16,235 (32.0) | 10,167 (20.0) | 14,220 (28.0) | 10,152 (20.0) | 50,774 | |
TB patients diagnosed | DS-TB patients | 783 (32.4) | 525 (21.7) | 619 (25.6) | 487 (20.2) | 2414 |
DR-TB patients | 7 (26.9) | 9 (34.6) | 5 (19.2) | 5 (19.2) | 26 | |
TB patients started on treatment | DS-TB patients | 747 (32.7) | 491 (21.5) | 594 (26.0) | 455 (19.9) | 2287 |
DR-TB patients | 5 (25.0) | 6 (30.0) | 5 (25.0) | 4 (20.0) | 20 |
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Nwokoye, N.; Odume, B.; Nwadike, P.; Anaedobe, I.; Mangoro, Z.; Umoren, M.; Ogbudebe, C.; Chukwuogo, O.; Useni, S.; Nongo, D.; et al. Impact of the Stool-Based Xpert Test on Childhood Tuberculosis Diagnosis in Selected States in Nigeria. Trop. Med. Infect. Dis. 2024, 9, 100. https://doi.org/10.3390/tropicalmed9050100
Nwokoye N, Odume B, Nwadike P, Anaedobe I, Mangoro Z, Umoren M, Ogbudebe C, Chukwuogo O, Useni S, Nongo D, et al. Impact of the Stool-Based Xpert Test on Childhood Tuberculosis Diagnosis in Selected States in Nigeria. Tropical Medicine and Infectious Disease. 2024; 9(5):100. https://doi.org/10.3390/tropicalmed9050100
Chicago/Turabian StyleNwokoye, Nkiru, Bethrand Odume, Peter Nwadike, Ikechukwu Anaedobe, Zirra Mangoro, Michael Umoren, Chidubem Ogbudebe, Ogoamaka Chukwuogo, Sani Useni, Debby Nongo, and et al. 2024. "Impact of the Stool-Based Xpert Test on Childhood Tuberculosis Diagnosis in Selected States in Nigeria" Tropical Medicine and Infectious Disease 9, no. 5: 100. https://doi.org/10.3390/tropicalmed9050100