Age-specific effectiveness of a tuberculosis screening intervention in children

• Published in: PloS one Vol. 17; no. 2; p. e0264216
• Main Authors: Brooks, Meredith B., Dubois, Melanie M., Malik, Amyn A., Ahmed, Junaid F., Siddiqui, Sara, Khan, Salman, Brohi, Manzoor, Das Valecha, Teerath, Amanullah, Farhana, Becerra, Mercedes C., Hussain, Hamidah
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.02.2022; Public Library of Science (PLoS)
• Subjects: Adolescent; Age; Age Factors; Biology and Life Sciences; Biopsy; Blood tests; Caregivers; Child; Child, Preschool; Children; Children & youth; Data collection; Demographic aspects; Diagnosis; Diseases; Evaluation; Failure to thrive; Female; Fever; Health care networks; Hospitals; Humans; Infant; Infectious diseases; Intervention; Male; Mass Screening - standards; Mean; Medical diagnosis; Medical screening; Medicine and Health Sciences; Pakistan; Pediatrics; People and Places; R&D; Research & development; Screening; Standard deviation; Sweating; Tomography; Tuberculosis; Tuberculosis - epidemiology; Tuberculosis - prevention & control; Ultrasonic imaging; Pakistan; Singapore; United States > US; Massachusetts; Karachi Pakistan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264216

To apply a cascade-of-care framework to evaluate the effectiveness-by age of the child-of an intensified tuberculosis patient-finding intervention. From a prospective screening program at four hospitals in Pakistan (2014-2016) we constructed a care cascade comprising six steps: screened, positive screen, evaluated, diagnosed, started treatment, and successful outcome. We evaluated the cascade by each year of age from 0 to 14 and report the age-specific mean proportion and standard deviation. On average across all ages, only 12.5% (standard deviation: 2.0%) of children with a positive screen were not evaluated. Among children who had a complete evaluation, the highest percentages of children diagnosed with tuberculosis were observed in children 0-4 (mean: 31.9%; standard deviation: 4.8%), followed by lower percentages in children 5-9 (mean: 22.4%; standard deviation: 2.2%), and 10-14 (mean: 26.0%; standard deviation:5.4%). Nearly all children diagnosed with tuberculosis initiated treatment, and an average of 93.3% (standard deviation: 3.3%) across all ages had successful treatment outcomes. This intervention was highly effective across ages 0-14 years. Our study illustrates the utility of applying operational analyses of age-stratified cascades to identify age-specific gaps in pediatric tuberculosis care that can guide future, novel interventions to close these gaps.