Project Lead(s): Daniel Datiko
Tuberculosis (TB) is a major public health problem worldwide, with the highest burden in low-income populations. While TB in children is common, its diagnosis is difficult in low-resource settings.
A community-based project was initiated to increase the number of children diagnosed with TB through a combination of community-based active case-finding, pooling of multiple samples and testing with a single test (Gene Xpert) to increase the yield and diagnostic access for TB in a high-burden setting.
Symptomatic children were examined and referred to the nearest health centre for X-rays, and – following international World Health Organization (WHO) guidelines – were offered Gene Xpert MTB-RIF testing, if available.
Because testing only one specimen with Xpert in children results in identifying only a small proportion (typically 20%) of patients with a positive result, pooling at least two samples (to be tested together with one Xpert cartridge) was evaluated to see if it would increase the yield of children confirmed to have TB, compared to using smear microscopy.
Households with known index cases were identified in the districts of the Sidama zone in Southern Ethiopia. They identified 350 children from the community and collected 235 sputum samples, 109 gastric aspirates and 7 samples for fine needle aspirate (FNA).
Children with enlarged lymph nodes had FNA at the University of Hawassa.
The project was seen as being very successful.
Researchers were able to access children with symptoms of TB (mainly a cough) and arranged transportation for health facility screening, using gastric aspirates and sputum specimen collection.
In the community, they identified index TB cases and screened their household members, including adults and children.
Awareness of health workers and the community was raised about TB in children, along with the availability of tests for remote and rural settings.
The findings for the Xpert and sputum microscopy testing were promising; larger-scale testing of the samples needs further validation.
Knowledge of the project was disseminated through publications.
The project team linked the project work with the PhD program in Addis Ababa University and it will be part of the PhD dissertation on capacity-building for the University of Hawassa.