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Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia

Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCW...

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Autores principales: Joshi, Basant, De Lima, Yara Voss, Massom, Douglas Mbang, Kaing, Sanary, Banga, Marie-France, Kamara, Egerton Tamba, Sesay, Sheriff, Borand, Laurence, Taguebue, Jean-Voisin, Moh, Raoul, Khosa, Celso, Breton, Guillaume, Mwanga-Amumpaire, Juliet, Bonnet, Maryline, Wobudeya, Eric, Marcy, Olivier, Orne-Gliemann, Joanna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10566691/
https://www.ncbi.nlm.nih.gov/pubmed/37819919
http://dx.doi.org/10.1371/journal.pgph.0001525
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author Joshi, Basant
De Lima, Yara Voss
Massom, Douglas Mbang
Kaing, Sanary
Banga, Marie-France
Kamara, Egerton Tamba
Sesay, Sheriff
Borand, Laurence
Taguebue, Jean-Voisin
Moh, Raoul
Khosa, Celso
Breton, Guillaume
Mwanga-Amumpaire, Juliet
Bonnet, Maryline
Wobudeya, Eric
Marcy, Olivier
Orne-Gliemann, Joanna
author_facet Joshi, Basant
De Lima, Yara Voss
Massom, Douglas Mbang
Kaing, Sanary
Banga, Marie-France
Kamara, Egerton Tamba
Sesay, Sheriff
Borand, Laurence
Taguebue, Jean-Voisin
Moh, Raoul
Khosa, Celso
Breton, Guillaume
Mwanga-Amumpaire, Juliet
Bonnet, Maryline
Wobudeya, Eric
Marcy, Olivier
Orne-Gliemann, Joanna
author_sort Joshi, Basant
collection PubMed
description Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs’ perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d’Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020–21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR.
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spelling pubmed-105666912023-10-12 Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia Joshi, Basant De Lima, Yara Voss Massom, Douglas Mbang Kaing, Sanary Banga, Marie-France Kamara, Egerton Tamba Sesay, Sheriff Borand, Laurence Taguebue, Jean-Voisin Moh, Raoul Khosa, Celso Breton, Guillaume Mwanga-Amumpaire, Juliet Bonnet, Maryline Wobudeya, Eric Marcy, Olivier Orne-Gliemann, Joanna PLOS Glob Public Health Research Article Decentralizing childhood tuberculosis services, including diagnosis, is now recommended by the WHO and could contribute to increasing tuberculosis detection in high burden countries. However, implementing microbiological tests and clinical evaluation could be challenging for health care workers (HCWs) in Primary Health Centers (PHCs) and even District Hospitals (DHs). We sought to assess the acceptability of decentralizing a comprehensive childhood tuberculosis diagnosis package from HCWs’ perspective. We conducted implementation research nested within the TB-Speed Decentralization study. HCWs from two health districts of Cambodia, Cameroon, Côte d’Ivoire, Mozambique, Sierra Leone, and Uganda implemented systematic screening, nasopharyngeal aspirates (NPA) and stool sample collection with molecular testing, clinical evaluation and chest X-ray (CXR) interpretation. We investigated their experiences and perceptions in delivering the diagnostic package components in 2020–21 using individual semi-structured interviews. We conducted thematic analysis, supported by the Theoretical Framework of Acceptability. HCWs (n = 130, 55% female, median age 36 years, 53% nurses, 72% PHC-based) perceived that systematic screening, although increasing workload, was beneficial as it improved childhood tuberculosis awareness. Most HCWs shared satisfaction and confidence in performing NPA, despite procedure duration, need to involve parents/colleagues and discomfort for children. HCWs shared positive attitudes towards stool sample-collection but were frustrated by delayed stool collection associated with cultural practices, transport and distance challenges. Molecular testing, conducted by nurses or laboratory technicians, was perceived as providing quality results, contributing to diagnosis. Clinical evaluation and diagnosis raised self-efficacy issues and need for continuous training and clinical mentoring. HCWs valued CXR, however complained that technical and logistical problems limited access to digital reports. Referral from PHC to DH was experienced as burdensome. HCWs at DH and PHC-levels perceived and experienced decentralized childhood tuberculosis diagnosis as acceptable. Implementation however could be hampered by feasibility issues, and calls for innovative referral mechanisms for patients, samples and CXR. Public Library of Science 2023-10-11 /pmc/articles/PMC10566691/ /pubmed/37819919 http://dx.doi.org/10.1371/journal.pgph.0001525 Text en © 2023 Joshi et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Joshi, Basant
De Lima, Yara Voss
Massom, Douglas Mbang
Kaing, Sanary
Banga, Marie-France
Kamara, Egerton Tamba
Sesay, Sheriff
Borand, Laurence
Taguebue, Jean-Voisin
Moh, Raoul
Khosa, Celso
Breton, Guillaume
Mwanga-Amumpaire, Juliet
Bonnet, Maryline
Wobudeya, Eric
Marcy, Olivier
Orne-Gliemann, Joanna
Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia
title Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia
title_full Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia
title_fullStr Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia
title_full_unstemmed Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia
title_short Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia
title_sort acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: experiences and perceptions from health care workers in sub-saharan africa and south-east asia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10566691/
https://www.ncbi.nlm.nih.gov/pubmed/37819919
http://dx.doi.org/10.1371/journal.pgph.0001525
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