Impact of systematic early tuberculosis detection using Xpert MTB/RIF Ultra in children with severe pneumonia in high tuberculosis burden countries (TB-Speed pneumonia): a stepped wedge cluster randomized trial

Background In high tuberculosis (TB) burden settings, there is growing evidence that TB is common in children with pneumonia, the leading cause of death in children under 5 years worldwide. The current WHO standard of care (SOC) for young children with pneumonia considers a diagnosis of TB only if the child has a history of prolonged symptoms or fails to respond to antibiotic treatments. As a result, many children with TB-associated severe pneumonia are currently missed or diagnosed too late. We therefore propose a diagnostic trial to assess the impact on mortality of adding the systematic early detection of TB using Xpert MTB/RIF Ultra (Ultra) performed on nasopharyngeal aspirates (NPA) and stool samples to the WHO SOC for children with severe pneumonia, followed by immediate initiation of anti-TB treatment in children testing positive on any of the samples. Methods TB-Speed Pneumonia is a pragmatic stepped-wedge cluster randomized controlled trial conducted in six countries with high TB incidence rate (Côte d’Ivoire, Cameroon, Uganda, Mozambique, Zambia and Cambodia). We will enrol 3780 children under 5 years presenting with WHO-defined severe pneumonia across 15 hospitals over 18 months. All hospitals will start managing children using the WHO SOC for severe pneumonia; one hospital will be randomly selected to switch to the intervention every 5 weeks. The intervention consists of the WHO SOC plus rapid TB detection on the day of admission using Ultra performed on 1 nasopharyngeal aspirate and 1 stool sample. All children will be followed for 3 months, with systematic trial visits at day 3, discharge, 2 weeks post-discharge, and week 12. The primary endpoint is all-cause mortality 12 weeks after inclusion. Qualitative and health economic evaluations are embedded in the trial. Discussion In addition to testing the main hypothesis that molecular detection and early treatment will reduce TB mortality in children, the strength of such pragmatic research is that it provides some evidence regarding the feasibility of the intervention as part of routine care. Should this intervention be successful, safe and well tolerated, it could be systematically implemented at district hospital level where children with severe pneumonia are referred. Trial registration ClinicalTrials.gov, NCT03831906. Registered 6 February 2019

Allaitement exclusif: prévalence et impact sur la morbidité des enfants hospitalisés dans le service de pédiatrie du CHU de Yopougon, Côte d’Ivoire

Contexte: La Côte d’Ivoire a déclaré l’année 2015 comme l’année de l’allaitement exclusif (AE) pour améliorer le taux d’allaitement maternel de 12% à 50% en 2020.Objectif: Décrire la pratique de l’AE par les mères des enfants hospitalisés dans le service de pédiatrie du CHU de Yopougon.Patients et méthode: Cette étude transversale a été menée dans le service de pédiatrie du CHU de Yopougon entre le 1er janvier et le 30 juin 2017. Les mères ont été interrogées de façon systématique à l’aide d’un questionnaire standardisé pendant l’hospitalisation pour apprécier la pratique de l’AE. Les données sociodémographiques des mères et des enfants ainsi que les données cliniques des enfants ont été recueillies. Les données ont été analysées par le logiciel epi-Info7. Le test de Fisher a été utilisé pour la comparaison des fréquences au seuil de significativité de 5%.Résultats: L’âge moyen des mères étaient de 26,0 ans (ET = 5,5). Le taux de non pratique de l’AME était de 53%. Les raisons étaient principalement la quantité insuffisante de lait de mère (36,4%), la soif de l’enfant (28,8%), l’activité professionnelle ou la scolarité des mères (15,4%) et l’hospitalisation de la mère (9,6%). L’âge moyen des enfants étaient de 7,1 mois (ET = 3,6). Il y avait une relation statistiquement significative entre le paludisme grave (p = 0,0001), la bronchiolite (p = 0,006), la diarrhée (p = 0,04) et la pratique de l’AE.Conclusion: la pratique de l’AE est entravée par des croyances et connaissances des mères vues en hospitalisation et responsable d’une morbidité significativement plus importante chez les enfants.Mots-clés: Allaitement, hospitalisation, pédiatrie, Côte d’IvoireEnglish Title: Exclusive breastfeeding: prevalence and impact on morbidity of children hospitalized in the pediatric department of Yopougon University Hospital, Côte d’IvoireEnglish AbstractBackground: Côte d'Ivoire has declared 2015 the year of exclusive breastfeeding (EBF) to improve breastfeeding rates from 12% to 50% by 2020. Objective: To describe the practice of EBF by mothers of children hospitalized in the pediatric department of Yopougon University Hospital.Patients and methods: This cross-sectional study was conducted in the pediatric  department of Yopougon University Hospital between January 1 and June 30, 2017. Mothers were systematically interviewed using a standardized questionnaire administered during hospitalization to appreciate the practice of EBF and sociodemographic, clinical data of mothers and children. The data was analyzed by Epi-Info7 software. The Fisher test was used to compare the frequencies at the significance level of 5%.Results: The mean age of mothers was 26.0 years (SD = 5.5). The non-practical rate of EBF was 53%. The reasons were mainly insufficient quantity of mother's milk (36.4%), thirst of child (28.8%), professional activity or schooling of mothers (15.4%) and mother hospitalization. The mean age of the children was 7.1 months (SD = 3.6). There was a statistically significant relationship between severe malaria (p = 0.0001), bronchiolitis (p = 0.006), diarrhea (p = 0.04) and the practice of EBF.Conclusion: the practice of EBF is hampered by beliefs and knowledge of mothers seen in hospitalization and is responsible for a significantly greater morbidity in children.Keywords: Breastfeeding, hospitalization, pediatrics, Côte d’Ivoir