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Cited by 14Tuberculosis Research and EpidemiologyGlobal Maternal and Child HealthSchool Health and Nursing Education

The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.

Evaluating the integration of tuberculosis screening and contact investigation in tuberculosis clinics in Ethiopia: A mixed method study

Open access
Ketema, L., Dememew, Z. G., Assefa, D., Gudina, T., Kassa, A., Letta, T., Ayele, B., Tadesse, Y., Tegegn, B., Datiko, D. G., Negeri, C., Bedru, A., Klinkenberg, E.·2020·PLOS ONE
DOI 10.1371/journal.pone.0241977PMC PMC7676707
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Abstract

Background: Aligned with global childhood tuberculosis (TB) road map, Ethiopia developed its own in 2015. The key strategies outlined in the Ethiopian roadmap are incorporating TB screening in Integrated Maternal, Neonatal and Child Illnesses (IMNCI) clinic for children under five years (U5) and intensifying contact investigations at TB clinic. However, these strategies have never been evaluated. Objective: To evaluate the integration of tuberculosis (TB) screening and contact investigation into Integrated Maternal, Neonatal and Child Illnesses (IMNCI) and TB clinics in Addis Ababa, Ethiopia. Methods: The study used mixed methods with stepped-wedge design where 30 randomly selected health care facilities were randomized into three groups of 10 during August 2016-November 2017. The integration of TB screening into IMNCI clinic and contact investigation in TB clinic were introduced by a three-day childhood TB training for health providers. An in-depth interview was used to explore the challenges of the interventions and supplemented data on TB screening and contact investigation. Results: Overall, 180896 children attended 30 IMNCI clinics and145444 (80.4%) were screened for TB. A total of 688 (0.4%) children had presumptive TB and 47(0.03%) had TB. During the pre-intervention period, 51873 of the 85278 children (60.8%) were screened for TB as compared to 93570 of the 95618 children (97.9%) in the intervention (p<0.001). This had resulted in 149 (0.30%) and 539 (0.6%) presumptive TB cases in pre-intervention and intervention periods (p<0.001), respectively. Also, nine TB cases (6.0%) in pre-intervention and 38 (7.1%) after intervention were identified (p = 0.72). In TB clinics, 559 under-five (U5) contacts were identified and 419 (80.1%) were screened. In all, 51(9.1%) presumed TB cases and 12 (2.1%) active TB cases were identified from the traced contacts. TB screening was done for 182 of the 275 traced contacts (66.2%) before intervention and for 237 of the 284 of the traced (83.5%) under intervention (p<0.001). Isoniazid prevention therapy (IPT) was initiated for 69 of 163 eligible contacts (42.3%) before intervention and for 159 of 194 eligible children (82.0%) under intervention (p<0.001). Over 95% of health providers indicated that the integration of TB screening into IMNCI and contact investigation in TB clinic is acceptable and practical. Gastric aspiration to collect sputum using nasogastric tube was reported to be difficult. Conclusions: Integrating TB screening into IMNCI clinics and intensifying contact investigation in TB clinics is feasible improving TB screening, presumed TB cases, TB cases, contact screening and IPT coverage during the intervention period. Stool specimen could be non-invasive to address the challenge of sputum collection.

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Crossref · 10.1371/journal.pone.0241977

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  • Health care facilities in Ketema et al. 2020 were randomized into three groups of ten during August 2016-November 2017.

    “Health care facilities were randomized into three groups of ten during August 2016-November 2017.”

    From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [74]

  • The stepped-wedge design in Ketema et al. 2020 allows for all clusters to eventually receive the intervention while providing a rigorous evaluation of its effectiveness.

    “This design allows for all clusters to eventually receive the intervention while providing a rigorous evaluation of its effectiveness”

    From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [74]

  • The sample size calculations in Ketema et al. 2020 focused on detecting differences in TB screening rates, presumptive TB cases, and IPT initiation rates.

    “The sample size calculations focused on detecting differences in TB screening rates, presumptive TB cases, and IPT initiation rates”

    From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [74]

    The Materials and methods sections on Sampling and Data analysis describe how facilities were selected and how TB screening, presumptive TB, and IPT outcomes were compared. Neither section reports sample-size calculations or says those calculations were designed to detect differences in these outcomes (searched: sample size calculation and power). (LLM, conf=0.77)

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Research works printed but not linked: 6

  1. WHO, 2013, Roadmap for childhood tuberculosis: towards zero deaths
  2. 2014, Guidance for national tuberculosis programs on the management of tuberculosis in children
  3. 2015, National Roadmap for Prevention and Control of Childhood TB in Ethiopia
  4. Dawit Assefa, 2015, Contact Investigation in Addis Ababa, Missed Opportunity to Prevent TB in Children, PLOS ONE
  5. World Population Review. Addis Ababa Population 2015. http://worldpopulationreview.com/world-cities/addis-ababa-population/
  6. National Guideline for programmatic and Clinical Management of TB, TB/HIV, Leprosy in Ethiopia, 6th Edition, FMOH 2016. Avaiabe from: https://www.slideshare.net/suleymanfantahun/new-ethiopian-tb-guildline-november-2016

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Metadata

Authors
Ketema, L., Dememew, Z. G., Assefa, D., Gudina, T., Kassa, A., Letta, T., Ayele, B., Tadesse, Y., Tegegn, B., Datiko, D. G., Negeri, C., Bedru, A., & Klinkenberg, E.
Affiliations
  • United States Agency for International Development (US)
  • Federal Ministry of Health (ET)
  • Addis Ababa City Administration Health Bureau (ET)
  • Amsterdam UMC Location University of Amsterdam (NL)
Corresponding author
Dememew, Z. G.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2020-11-19
Volume
15
Issue
11
Pages
e0241977
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0241977
PMC
PMC7676707
OpenAlex
W3098474034
Cited by
13
References
37
Citations by year
2026: 2 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 1
FWCI
0.23
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Greater South Information System
Funders
  • United States Agency for International Development
  • Strong
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › School Health and Nursing Education
Keywords
pediatric tuberculosis, tuberculosis screening, contact investigation, children under five, tuberculosis case detection, health professions education, Ethiopia, Addis Ababa, stepped wedge design, health system integration, health information systems, health policy evaluation
MeSH terms
Adult, Child, Ethiopia, Female, Humans, Isoniazid, Male, Mass Screening, Tuberculosis, Contact Tracing

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