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  1. Article ; Online: Accuracy of computer-aided chest X-ray in community-based tuberculosis screening

    Brenda Mungai / Jane Ong'angò / Chu Chang Ku / Marc Y R Henrion / Ben Morton / Elizabeth Joekes / Elizabeth Onyango / Richard Kiplimo / Dickson Kirathe / Enos Masini / Joseph Sitienei / Veronica Manduku / Beatrice Mugi / Stephen Bertel Squire / Peter MacPherson / IMPALA Consortium

    PLOS Global Public Health, Vol 2, Iss 11, p e

    Lessons from the 2016 Kenya National Tuberculosis Prevalence Survey.

    2022  Volume 0001272

    Abstract: Community-based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer-aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product ... ...

    Abstract Community-based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer-aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product profiles (TPP) for community-based screening. CXR images from participants in the 2016 Kenya National TB Prevalence Survey were evaluated using CAD4TBv6 (Delft Imaging), giving a probabilistic score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). We constructed a Bayesian latent class model to estimate the accuracy of CAD4TBv6 screening compared to bacteriologically-confirmed TB across CAD4TBv6 threshold cut-offs, incorporating data on Clinical Officer CXR interpretation, participant demographics (age, sex, TB symptoms, previous TB history), and sputum results. We compared model-estimated sensitivity and specificity of CAD4TBv6 to optimum and minimum TPPs. Of 63,050 prevalence survey participants, 61,848 (98%) had analysable CXR images, and 8,966 (14.5%) underwent sputum bacteriological testing; 298 had bacteriologically-confirmed pulmonary TB. Median CAD4TBv6 scores for participants with bacteriologically-confirmed TB were significantly higher (72, IQR: 58-82.75) compared to participants with bacteriologically-negative sputum results (49, IQR: 44-57, p<0.0001). CAD4TBv6 met the optimum TPP; with the threshold set to achieve a mean sensitivity of 95% (optimum TPP), specificity was 83.3%, (95% credible interval [CrI]: 83.0%-83.7%, CAD4TBv6 threshold: 55). There was considerable variation in accuracy by participant characteristics, with older individuals and those with previous TB having lowest specificity. CAD4TBv6 met the optimal TPP for TB community screening. To optimise screening accuracy and efficiency of confirmatory sputum testing, we recommend that an adaptive approach to threshold setting is adopted based on participant characteristics.
    Keywords Public aspects of medicine ; RA1-1270
    Subject code 310
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Kenya tuberculosis prevalence survey 2016

    Masini Enos / Joseph Sitienei / Jane Ong'ang'o / Brenda Mungai / Maureen Kamene / Jesse Wambugu / Hillary Kipruto / Veronica Manduku / Josephine Mburu / Drusilla Nyaboke / Faith Ngari / Eunice Omesa / Newton Omale / Nkirote Mwirigi / Geoffrey Okallo / Janice Njoroge / Martin Githiomi / Mike Mwangi / Dickson Kirathe /
    Richard Kiplimo / Amos Ndombi / Lazarus Odeny / Eunice Mailu / Timothy Kandie / Maurice Maina / Kadondi Kasera / Beatrice Mulama / Beatrice Mugi / Herman Weyenga

    PLoS ONE, Vol 13, Iss 12, p e

    Challenges and opportunities of ending TB in Kenya.

    2018  Volume 0209098

    Abstract: Background We aimed to determine the prevalence of pulmonary TB amongst the adult population (≥15 years) in 2016 in Kenya. Method A nationwide cross-sectional survey where participants first underwent TB symptom screening and chest x-ray. Subsequently, ... ...

    Abstract Background We aimed to determine the prevalence of pulmonary TB amongst the adult population (≥15 years) in 2016 in Kenya. Method A nationwide cross-sectional survey where participants first underwent TB symptom screening and chest x-ray. Subsequently, participants who reported cough >2weeks and/or had a chest x-ray suggestive of TB, submitted sputum specimen for laboratory examination by smear microscopy, culture and Xpert MTB/RIF. Result The survey identified 305 prevalent TB cases translating to a prevalence of 558 [95%CI 455-662] per 100,000 adult population. The highest disease burden was reported among people aged 25-34 years (716 [95% CI 526-906]), males (809 [(95% CI 656-962]) and those who live in urban areas (760 [95% CI 539-981]). Compared to the reported TB notification rate for Kenya in 2016, the prevalence to notification ratio was 2.5:1. The gap between the survey prevalence and notification rates was highest among males, age groups 25-34, and the older age group of 65 years and above. Only 48% of the of the survey prevalent cases reported cough >2weeks. In addition, only 59% of the identified cases had the four cardinal symptoms for TB (cough ≥2 weeks, fever, night sweat and weight loss. However, 88.2% had an abnormal chest x-ray suggestive of TB. The use of Xpert MTB/RIF identified 77.7% of the cases compared to smear microscopy's 46%. Twenty-one percent of the survey participants with respiratory symptoms reported to have sought prior health care at private clinics and chemists. Among the survey prevalent cases who reported TB related symptoms, 64.9% had not sought any health care prior to the survey. Conclusion This survey established that TB prevalence in Kenya is higher than had been estimated, and about half of the those who fall ill with the disease each year are missed.
    Keywords Medicine ; R ; Science ; Q
    Subject code 310
    Language English
    Publishing date 2018-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Case Definition of Chronic Pulmonary Aspergillosis in Resource-Constrained Settings

    David W. Denning / Iain D. Page / Jeremiah Chakaya / Kauser Jabeen / Cecilia M. Jude / Muriel Cornet / Ana Alastruey-Izquierdo / Felix Bongomin / Paul Bowyer / Arunaloke Chakrabarti / Sara Gago / John Guto / Bruno Hochhegger / Martin Hoenigl / Muhammad Irfan / Nicholas Irurhe / Koichi Izumikawa / Bruce Kirenga / Veronica Manduku /
    Samihah Moazam / Rita O. Oladele / Malcolm D. Richardson / Juan Luis Rodriguez Tudela / Anna Rozaliyani / Helmut J.F. Salzer / Richard Sawyer / Nasilele F. Simukulwa / Alena Skrahina / Charlotte Sriruttan / Findra Setianingrum / Bayu A.P. Wilopo / Donald C. Cole / Haileyesus Getahun

    Emerging Infectious Diseases, Vol 24, Iss 8, Pp - (2018)

    2018  

    Abstract: Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had ... ...

    Abstract Chronic pulmonary aspergillosis (CPA) is a recognized complication of pulmonary tuberculosis (TB). In 2015, the World Health Organization reported 2.2 million new cases of nonbacteriologically confirmed pulmonary TB; some of these patients probably had undiagnosed CPA. In October 2016, the Global Action Fund for Fungal Infections convened an international expert panel to develop a case definition of CPA for resource-constrained settings. This panel defined CPA as illness for >3 months and all of the following: 1) weight loss, persistent cough, and/or hemoptysis; 2) chest images showing progressive cavitary infiltrates and/or a fungal ball and/or pericavitary fibrosis or infiltrates or pleural thickening; and 3) a positive Aspergillus IgG assay result or other evidence of Aspergillus infection. The proposed definition will facilitate advancements in research, practice, and policy in lower- and middle-income countries as well as in resource-constrained settings.
    Keywords Tuberculosis ; Aspergillus ; antibody ; aspergilloma ; imaging ; developing countries ; Medicine ; R ; Infectious and parasitic diseases ; RC109-216
    Language English
    Publishing date 2018-08-01T00:00:00Z
    Publisher Centers for Disease Control and Prevention
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Sodium stibogluconate (SSG) & paromomycin combination compared to SSG for visceral leishmaniasis in East Africa

    Ahmed Musa / Eltahir Khalil / Asrat Hailu / Joseph Olobo / Manica Balasegaram / Raymond Omollo / Tansy Edwards / Juma Rashid / Jane Mbui / Brima Musa / Abuzaid Abdalla Abuzaid / Osama Ahmed / Ahmed Fadlalla / Ahmed El-Hassan / Marius Mueller / Geoffrey Mucee / Simon Njoroge / Veronica Manduku / Geoffrey Mutuma /
    Lilian Apadet / Hudson Lodenyo / Dedan Mutea / George Kirigi / Sisay Yifru / Getahun Mengistu / Zewdu Hurissa / Workagegnehu Hailu / Teklu Weldegebreal / Hailemariam Tafes / Yalemtsehay Mekonnen / Eyasu Makonnen / Serah Ndegwa / Patrick Sagaki / Robert Kimutai / Josephine Kesusu / Rhoda Owiti / Sally Ellis / Monique Wasunna

    PLoS Neglected Tropical Diseases, Vol 6, Iss 6, p e

    a randomised controlled trial.

    2012  Volume 1674

    Abstract: Alternative treatments for visceral leishmaniasis (VL) are required in East Africa. Paromomycin sulphate (PM) has been shown to be efficacious for VL treatment in India.A multi-centre randomized-controlled trial (RCT) to compare efficacy and safety of PM ...

    Abstract Alternative treatments for visceral leishmaniasis (VL) are required in East Africa. Paromomycin sulphate (PM) has been shown to be efficacious for VL treatment in India.A multi-centre randomized-controlled trial (RCT) to compare efficacy and safety of PM (20 mg/kg/day for 21 days) and PM plus sodium stibogluconate (SSG) combination (PM, 15 mg/kg/day and SSG, 20 mg/kg/day for 17 days) with SSG (20 mg/kg/day for 30 days) for treatment of VL in East Africa. Patients aged 4-60 years with parasitologically confirmed VL were enrolled, excluding patients with contraindications. Primary and secondary efficacy outcomes were parasite clearance at 6-months follow-up and end of treatment, respectively. Safety was assessed mainly using adverse event (AE) data.The PM versus SSG comparison enrolled 205 patients per arm with primary efficacy data available for 198 and 200 patients respectively. The SSG & PM versus SSG comparison enrolled 381 and 386 patients per arm respectively, with primary efficacy data available for 359 patients per arm. In Intention-to-Treat complete-case analyses, the efficacy of PM was significantly lower than SSG (84.3% versus 94.1%, difference = 9.7%, 95% confidence interval, CI: 3.6 to 15.7%, p = 0.002). The efficacy of SSG & PM was comparable to SSG (91.4% versus 93.9%, difference = 2.5%, 95% CI: -1.3 to 6.3%, p = 0.198). End of treatment efficacy results were very similar. There were no apparent differences in the safety profile of the three treatment regimens.The 17 day SSG & PM combination treatment had a good safety profile and was similar in efficacy to the standard 30 day SSG treatment, suggesting suitability for VL treatment in East Africa.www.clinicaltrials.govNCT00255567.
    Keywords Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
    Subject code 610
    Language English
    Publishing date 2012-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: Geographical variation in the response of visceral leishmaniasis to paromomycin in East Africa

    Asrat Hailu / Ahmed Musa / Monique Wasunna / Manica Balasegaram / Sisay Yifru / Getahun Mengistu / Zewdu Hurissa / Workagegnehu Hailu / Teklu Weldegebreal / Samson Tesfaye / Eyasu Makonnen / Eltahir Khalil / Osama Ahmed / Ahmed Fadlalla / Ahmed El-Hassan / Muzamil Raheem / Marius Mueller / Yousif Koummuki / Juma Rashid /
    Jane Mbui / Geoffrey Mucee / Simon Njoroge / Veronica Manduku / Alice Musibi / Geoffrey Mutuma / Fredrick Kirui / Hudson Lodenyo / Dedan Mutea / George Kirigi / Tansy Edwards / Peter Smith / Lawrence Muthami / Catherine Royce / Sally Ellis / Moses Alobo / Raymond Omollo / Josephine Kesusu / Rhoda Owiti / John Kinuthia / Leishmaniasis East Africa Platform (LEAP) group

    PLoS Neglected Tropical Diseases, Vol 4, Iss 10, p e

    a multicentre, open-label, randomized trial.

    2010  Volume 709

    Abstract: Visceral leishmaniasis (VL) is a major health problem in developing countries. The untreated disease is fatal, available treatment is expensive and often toxic, and drug resistance is increasing. Improved treatment options are needed. Paromomycin was ... ...

    Abstract Visceral leishmaniasis (VL) is a major health problem in developing countries. The untreated disease is fatal, available treatment is expensive and often toxic, and drug resistance is increasing. Improved treatment options are needed. Paromomycin was shown to be an efficacious first-line treatment with low toxicity in India.This was a 3-arm multicentre, open-label, randomized, controlled clinical trial to compare three treatment regimens for VL in East Africa: paromomycin sulphate (PM) at 15 mg/kg/day for 21 days versus sodium stibogluconate (SSG) at 20 mg/kg/day for 30 days; and the combination of both dose regimens for 17 days. The primary efficacy endpoint was cure based on parasite-free tissue aspirates taken 6 months after treatment.Overall, 135 patients per arm were enrolled at five centres in Sudan (2 sites), Kenya (1) and Ethiopia (2), when the PM arm had to be discontinued due to poor efficacy. The trial has continued with the higher dose of PM as well as the combination of PM and SSG arms. These results will be reported later. Baseline patient characteristics were similar among treatment arms. The overall cure with PM was significantly inferior to that with SSG (63.8% versus 92.2%; difference 28.5%, 95%CI 18.8% to 38.8%, p<0.001). The efficacy of PM varied among centres and was significantly lower in Sudan (14.3% and 46.7%) than in Kenya (80.0%) and Ethiopia (75.0% and 96.6%). No major safety issues with PM were identified.The efficacy of PM at 15 mg/kg/day for 21 days was inadequate, particularly in Sudan. The efficacy of higher doses and the combination treatment warrant further studies.
    Keywords Arctic medicine. Tropical medicine ; RC955-962 ; Public aspects of medicine ; RA1-1270
    Subject code 630
    Language English
    Publishing date 2010-10-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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