Abstract
Background: Childhood tuberculosis accounts for about 10% of estimated TB cases in the world. Despite advances in diagnostics, childhood TB remains a challenge. We evaluated pooling method and testing with GeneXpert MTB/RIF in southern Ethiopia. Methods: This is a cross-sectional study in presumptive TB children < 15 years. Structured questionnaire was used to collect socio-demographic and clinical data. Two sputum or gastric aspirate sample were collected and examined by ZN and Xpert MTB/RIF for 1st, 2nd and pooled samples. Results: Of 340 presumptive TB cases enrolled, 96 and 244 children submitted gastric aspirate and sputum samples respectively. Of 1020 samples collected (282 gastric aspirate and 738 sputum samples), 38 (3.7%) were positive by Xpert (10 (3.5%) from gastric aspirate and 28 (3.8%) from sputum sample). Similarly, 8 (1.2%) of sputum samples were positive by ZN but none from gastric aspirate. Of 244 children who submitted sputum samples, 3 (1.2%) were bacteriologically positive compared to 12 (4.9%) by Xpert. Of 96 children who submitted gastric aspirate samples, none were positive by ZN while 5 (5.2%) were positive by Xpert. Of bacteriologically confirmed TB cases 0.9% was by ZN and 4.7% by Xpert, an increase of 3.8%. Pooled testing increased positivity by 0.3% for ZN and 1.5% by Xpert compared to the 1st sample. Conclusions: Xpert MTB/RIF testing increases yield compared to ZN testing for gastric aspirate samples. The same-day approach and pooling samples improves efficient use of cartridge, reduce the number of visits for seeking diagnosis and save resources.
Highlights
Childhood tuberculosis accounts for about 10% of estimated TB cases in the world
We evaluated pooling method and testing with GeneXpert MTB/RIF in southern Ethiopia
Cognizant of the low case finding and poor diagnostic yield, we aimed to evaluate if using pooled sample testing could increase the yield compared to individual tests and to evaluate Xpert results against the routine microscopy
Summary
Childhood tuberculosis (TB) accounts for about 10% of globally estimated new TB cases [1] and remains among top diseases causing the highest morbidity and mortality among children admitted for treatment [2]. Childhood TB prevention and control were not a priority as the capacity to pick adult TB is yet to be improved This creates safe haven for TB transmission from adults to children [5]. Ethiopia like other developing countries, childhood tuberculosis was not given priority and the health facilities were not adequately organized to give access to the majority of rural communities. Cognizant of the low case finding and poor diagnostic yield, we aimed to evaluate if using pooled sample testing could increase the yield compared to individual tests and to evaluate Xpert results against the routine microscopy
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