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1. Development of tuberculosis treatment decision algorithms in children below 5 years hospitalised with severe acute malnutrition in Zambia and Uganda: a prospective diagnostic cohort study

Author

Chabala, C, Roucher, C, Ton Nu Nguyet, MH, Babirekere, E, Inambao, M, Businge, G, Kapula, C, Shankalala, P, Nduna, B, Mulenga, V, Graham, S, Wobudeya, E, Bonnet, M, Marcy, O, Serre, A, Badrichani, A, Razafimanantsoa, M, Poublan, J, Vessière, A, Occelli, E, Beuscart, A, Charpin, A, Habiyambere, G, Mesnier, S, Balestre, E, Koskas, N, D'Elbée, M, Font, H, Lounnas, M, Espérou, H, Couffin-Cadiergues, S, Kuppers, A, Hamze, B, Namulinda, F, Sserunjogi, R, Nassozi, R, Barungi, C, Hellen, A, Doreen, M, Kagoya, E, Aciparu, S, Sophia, C, Ntambi, S, Wasswa, A, Nangozi, J, Hambulo, C, Kapotwe, V, Ngambi, M, Kasakwa, K, Kanyama, M, Chirwa, U, Chifunda, K, Mundundu, G, Zulu, S, Nawakwi, G, Siasulingana, T, Himwaze, DA, Chilonga, J, Chimbini, M, Chilanga, M, Chola, D, Mwango, E, Pumbwe, M, Mwambazi, M, Halende, B, Mumba, W, Mankunshe, E, Silavwe, M, Chakopo, M, Moono, R, Chungu, C, Zimba, K, Kapasa, M, Zyambo, K, Chabala, C, Roucher, C, Ton Nu Nguyet, MH, Babirekere, E, Inambao, M, Businge, G, Kapula, C, Shankalala, P, Nduna, B, Mulenga, V, Graham, S, Wobudeya, E, Bonnet, M, Marcy, O, Serre, A, Badrichani, A, Razafimanantsoa, M, Poublan, J, Vessière, A, Occelli, E, Beuscart, A, Charpin, A, Habiyambere, G, Mesnier, S, Balestre, E, Koskas, N, D'Elbée, M, Font, H, Lounnas, M, Espérou, H, Couffin-Cadiergues, S, Kuppers, A, Hamze, B, Namulinda, F, Sserunjogi, R, Nassozi, R, Barungi, C, Hellen, A, Doreen, M, Kagoya, E, Aciparu, S, Sophia, C, Ntambi, S, Wasswa, A, Nangozi, J, Hambulo, C, Kapotwe, V, Ngambi, M, Kasakwa, K, Kanyama, M, Chirwa, U, Chifunda, K, Mundundu, G, Zulu, S, Nawakwi, G, Siasulingana, T, Himwaze, DA, Chilonga, J, Chimbini, M, Chilanga, M, Chola, D, Mwango, E, Pumbwe, M, Mwambazi, M, Halende, B, Mumba, W, Mankunshe, E, Silavwe, M, Chakopo, M, Moono, R, Chungu, C, Zimba, K, Kapasa, M, and Zyambo, K

Abstract

Background: In children with severe acute malnutrition (SAM) tuberculosis is common, challenging to diagnose, and often fatal. We developed tuberculosis treatment decision algorithms (TDAs) for children under the age of 5 years with SAM. Methods: In this prospective diagnostic study, we enrolled and followed up children aged <60 months hospitalised with SAM at three tertiary hospitals in Zambia and Uganda from 4 November 2019 to 20 June 2022. We included children aged 2–59 months with SAM as defined by WHO and hospitalised following the WHO clinical criteria. We excluded children with current or history of antituberculosis treatment within the preceding 3 months. They underwent tuberculosis symptom screening, clinical assessment, chest X-ray, abdominal ultrasound, Xpert MTB/RIF Ultra (Ultra) and culture on respiratory and stool samples with 6 months follow-up. Tuberculosis was retrospectively defined using the 2015 standard case definition for childhood tuberculosis. We used logistic regression to develop diagnostic prediction models for a one-step diagnosis and a two-step screening and diagnostic approaches. We derived scores from models using WHO-recommended thresholds for sensitivity and proposed TDAs. This study is registered with ClinicalTrials.gov, NCT04240990. Findings: Of 1906 children hospitalised with SAM during the study period, 1230 were screened, 1152 were eligible and 603 were enrolled. Of the 603 children enrolled–median age 15 (inter-quartile range (IQR): 11–20) months and 65 (11.0%) living with HIV–114 (18.9%) were diagnosed with tuberculosis, including 51 (8.5%) with microbiological confirmation and 104 (17.2%) initiated treatment at a median of 6(IQR: 2–10) days after inclusion. 108 children were retrospectively classified as having tuberculosis resulting in a prevalence of 17.9% (95% confidence intervals (CI): 15.1; 21.2). 75 (69.4%) children with tuberculosis reported cough of any duration, 32 (29.6%) cough ≥2 weeks and 11 (10.2%) tuberculosis c

Published
2024

2. Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial

Author

Marcy, O, Wobudeya, E, Font, H, Vessière, A, Chabala, C, Khosa, C, Taguebue, J-V, Moh, R, Mwanga-Amumpaire, J, Lounnas, M, Mulenga, V, Mavale, S, Chilundo, J, Rego, D, Nduna, B, Shankalala, P, Chirwa, U, De Lauzanne, A, Dim, B, Tiogouo Ngouana, E, Folquet Amorrissani, M, Cisse, L, Amon Tanoh Dick, F, Komena, EA, Kwedi Nolna, S, Businge, G, Natukunda, N, Cumbe, S, Mbekeka, P, Kim, A, Kheang, C, Pol, S, Maleche-Obimbo, E, Seddon, JA, Mao, TE, Graham, SM, Delacourt, C, Borand, L, Bonnet, M, Serre, A, Badrichani, A, Razafimanantsoa, M, Poublan, J, Roucher, C, Occelli, E, Beuscart, A, Charpin, A, Habiyambere, G, Mesnier, S, Balestre, E, Bhatta, B, Maillard, A-L, Orne-Gliemann, J, Baillet, E, Koskas, N, D'Elbée, M, Gabillard, D, Huyen, M, Espérou, H, Couffin-Cadiergues, S, Kuppers, A, Hamze, B, BORAND, L, de LAUZANNE, A, DIM, B, Keang, C, PRING, L, YIN, S, SARITH, C, PHAN, C, NHEUONG, S, LY, S, KAING, S, SRENG, V, LUN, E, SAY, L, SUOM, S, FERHY, R, SO, D, BORN, S, PAL, S, NANG, B, MAO, TE, KIM, A, Srey, V, Kan, P, Hout, L, Ith, S, Oum, S, Sau, S, Ho, KH, Kith, D, Nuch, N, Horm, CL, Sophon, C, Roeungdeth, B, MENG, C, RITH, R, PHY, S, SOR, C, SAO, V, KHAT, S, MAK, B, UY, A, KHAY, S, SOM, K, HACH, R, SOK, H, KUON, S, HENG, S, SENG, A, NIM, S, PAN, R, KIM, S, SREY LEAP, K, NET, B, NOUN, V, LAY, D, MANY, C, Seng, S, Ly, V, So, S, Oun, S, CHEY, S, CHHEA, R, BAONG, L, THOUNG, V, KHEANG, C, BY, B, Nguon, V, MEACH, E, Tek, S, Ngeav, S, Lun, T, HEM, D, CHUT, N, SARIK, S, NANG, H, MEACH, M, SRENG, S, SAR, D, KIN, R, ROS, P, DORN, C, KAK, C, Sambath, SL, Son, L, Bin, L, Pengong, E, Khutsorn, S, Seang, S, Soun, V, Vong, V, Khoeung, C, Um, P, Bou, S, Song Pich, S, Nim, P, Khat, S, Ban Si, N, Ream, S, Ing, S, Chann, P, Ngeth, S, Sun, M, Chhoeung, S, Sean, S, Prak, R, Amboua Schouame Onambele, A, Hycenth, N, Melingui, B, Nkembe Medounmga, A, Hougnang Tatmi, L, Etemgoua, N, Kouesso, V, Bugin, J, Nzedjom, C, Ngoya, R, Eyike, J, Loudjom, E, Lonsti, R, Dang, L, Bintar, E, Njayong, C, Ngonsoa O, C, Ndzeukap, I, Dzoyem, P, Dzokou, C, Dindo, B, Aka Bony, R, Kouadio, C, Danho, S, Goli, M, Folquet, M, Itchy, MV, Sidibé, A, Cissé, L, Ouattara, J, Konaté, M, Amon-Tanoh Dick, F, Cardena, M, Adonis-Koffi, L, Eugenie, D, Kouamé, F, Menan, H, Inwoley, A, Ouassa, T, Nguessan, MS, Manhiça, E, Zitha, A, Chiúle, V, Muxanga, E, Gune, I, Lima, Y, Ribeiro, J, Maxanguana, F, Morais, N, Manhiça, J, Give, J, Atumane, J, Lucas, G, Thai, A, Chave, A, Guambe, L, Issa, F, Carneiro, R, Pene, N, Florindo, N, Machel, D, Cumbane, C, Mendes, H, Kitungwa, M, Muianga, V, Tamele, H, Sulude, A, Mabota, R, Comandante, H, Massangaie, A, Businge, GB, Namulinda, F, Sserunjogi, R, Nassozi, R, Barungi, C, Aanyu, H, Muwonge, D, Kagoya, E, Aciparu, S, Chemutai, S, Ntambi, S, Wasswa, A, Nangozi, J, Tagoola, A, Kenneth, S, Lubega, JP, Nassali, A, Tagobera, J, Agwang, C, Kalembe, F, Ajambo, A, Aguti, E, Kasibante, S, Matende, H, Odongo, IO, Mwanga Amumpaire, J, Ngabirano, G, Kakwenza, P, Nuwamanya, S, Nyangoma, M, Nabbuto, J, Abok, F, Arinaitwe, R, Birungi, D, Mwesigwa, E, Atwine, D, Mbega, H, Orikiriza, P, Taremwa, I, Turyashemererwa, E, Derrick, H, Nyehangane, D, Kaitano, R, Logoose, S, Businge, S, Ntambi, C, Mugabi, J, Mzee, J, Besigye, J, Kanzira, S, Turyatemba, P, Twebaze, F, Hambulo, C, Kapotwe, V, Ngambi, M, Kasakwa, K, Kapula, C, Zulu, S, Nawakwi, G, Siasulingana, T, Chilonga, J, Chimbini, M, Chilanga, M, Inambao, M, Mwambazi, M, Halende, B, Mumba, W, Mankunshe, E, Silavwe, M, Chakopo, M, Moono, R, Marcy, O, Wobudeya, E, Font, H, Vessière, A, Chabala, C, Khosa, C, Taguebue, J-V, Moh, R, Mwanga-Amumpaire, J, Lounnas, M, Mulenga, V, Mavale, S, Chilundo, J, Rego, D, Nduna, B, Shankalala, P, Chirwa, U, De Lauzanne, A, Dim, B, Tiogouo Ngouana, E, Folquet Amorrissani, M, Cisse, L, Amon Tanoh Dick, F, Komena, EA, Kwedi Nolna, S, Businge, G, Natukunda, N, Cumbe, S, Mbekeka, P, Kim, A, Kheang, C, Pol, S, Maleche-Obimbo, E, Seddon, JA, Mao, TE, Graham, SM, Delacourt, C, Borand, L, Bonnet, M, Serre, A, Badrichani, A, Razafimanantsoa, M, Poublan, J, Roucher, C, Occelli, E, Beuscart, A, Charpin, A, Habiyambere, G, Mesnier, S, Balestre, E, Bhatta, B, Maillard, A-L, Orne-Gliemann, J, Baillet, E, Koskas, N, D'Elbée, M, Gabillard, D, Huyen, M, Espérou, H, Couffin-Cadiergues, S, Kuppers, A, Hamze, B, BORAND, L, de LAUZANNE, A, DIM, B, Keang, C, PRING, L, YIN, S, SARITH, C, PHAN, C, NHEUONG, S, LY, S, KAING, S, SRENG, V, LUN, E, SAY, L, SUOM, S, FERHY, R, SO, D, BORN, S, PAL, S, NANG, B, MAO, TE, KIM, A, Srey, V, Kan, P, Hout, L, Ith, S, Oum, S, Sau, S, Ho, KH, Kith, D, Nuch, N, Horm, CL, Sophon, C, Roeungdeth, B, MENG, C, RITH, R, PHY, S, SOR, C, SAO, V, KHAT, S, MAK, B, UY, A, KHAY, S, SOM, K, HACH, R, SOK, H, KUON, S, HENG, S, SENG, A, NIM, S, PAN, R, KIM, S, SREY LEAP, K, NET, B, NOUN, V, LAY, D, MANY, C, Seng, S, Ly, V, So, S, Oun, S, CHEY, S, CHHEA, R, BAONG, L, THOUNG, V, KHEANG, C, BY, B, Nguon, V, MEACH, E, Tek, S, Ngeav, S, Lun, T, HEM, D, CHUT, N, SARIK, S, NANG, H, MEACH, M, SRENG, S, SAR, D, KIN, R, ROS, P, DORN, C, KAK, C, Sambath, SL, Son, L, Bin, L, Pengong, E, Khutsorn, S, Seang, S, Soun, V, Vong, V, Khoeung, C, Um, P, Bou, S, Song Pich, S, Nim, P, Khat, S, Ban Si, N, Ream, S, Ing, S, Chann, P, Ngeth, S, Sun, M, Chhoeung, S, Sean, S, Prak, R, Amboua Schouame Onambele, A, Hycenth, N, Melingui, B, Nkembe Medounmga, A, Hougnang Tatmi, L, Etemgoua, N, Kouesso, V, Bugin, J, Nzedjom, C, Ngoya, R, Eyike, J, Loudjom, E, Lonsti, R, Dang, L, Bintar, E, Njayong, C, Ngonsoa O, C, Ndzeukap, I, Dzoyem, P, Dzokou, C, Dindo, B, Aka Bony, R, Kouadio, C, Danho, S, Goli, M, Folquet, M, Itchy, MV, Sidibé, A, Cissé, L, Ouattara, J, Konaté, M, Amon-Tanoh Dick, F, Cardena, M, Adonis-Koffi, L, Eugenie, D, Kouamé, F, Menan, H, Inwoley, A, Ouassa, T, Nguessan, MS, Manhiça, E, Zitha, A, Chiúle, V, Muxanga, E, Gune, I, Lima, Y, Ribeiro, J, Maxanguana, F, Morais, N, Manhiça, J, Give, J, Atumane, J, Lucas, G, Thai, A, Chave, A, Guambe, L, Issa, F, Carneiro, R, Pene, N, Florindo, N, Machel, D, Cumbane, C, Mendes, H, Kitungwa, M, Muianga, V, Tamele, H, Sulude, A, Mabota, R, Comandante, H, Massangaie, A, Businge, GB, Namulinda, F, Sserunjogi, R, Nassozi, R, Barungi, C, Aanyu, H, Muwonge, D, Kagoya, E, Aciparu, S, Chemutai, S, Ntambi, S, Wasswa, A, Nangozi, J, Tagoola, A, Kenneth, S, Lubega, JP, Nassali, A, Tagobera, J, Agwang, C, Kalembe, F, Ajambo, A, Aguti, E, Kasibante, S, Matende, H, Odongo, IO, Mwanga Amumpaire, J, Ngabirano, G, Kakwenza, P, Nuwamanya, S, Nyangoma, M, Nabbuto, J, Abok, F, Arinaitwe, R, Birungi, D, Mwesigwa, E, Atwine, D, Mbega, H, Orikiriza, P, Taremwa, I, Turyashemererwa, E, Derrick, H, Nyehangane, D, Kaitano, R, Logoose, S, Businge, S, Ntambi, C, Mugabi, J, Mzee, J, Besigye, J, Kanzira, S, Turyatemba, P, Twebaze, F, Hambulo, C, Kapotwe, V, Ngambi, M, Kasakwa, K, Kapula, C, Zulu, S, Nawakwi, G, Siasulingana, T, Chilonga, J, Chimbini, M, Chilanga, M, Inambao, M, Mwambazi, M, Halende, B, Mumba, W, Mankunshe, E, Silavwe, M, Chakopo, M, and Moono, R

Abstract

Background: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality. Methods: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643). Findings: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597–1·630, p=0·957), and 74 (5·3%) children in the control group

Published
2022

3. An Unusual Cause of Lymphadenopathy: Rosai Dorfman Disease in a 7-Year-Old Female Zambian Child: Case Report and Literature Review.

Author

M'hango H, Chirwa U, Muhimba Z, Chilufya R, Mulopwe J, Mumba C, and Mpabalwani E

Abstract

Rosai Dorfman disease (RDD) is a rare non-Langerhans histiocytic disorder, which belongs to the R group of the 2016 revised histiocytic classification. It's characterized by the accumulation of activated histiocytes in the sinusoids of lymph nodes and/or extranodal tissues. Herein, we report a 7-year-old female who was initially suspected to have a lymphoma but was later identified as having RDD. She presented with a history of fever, night sweats, and weight loss, and on physical examination had bilateral cervical lymphadenopathy. Histologic examination of the biopsied cervical lymph nodes showed distended sinuses with S100 and CD68 immunoreactive histiocytes demonstrating emperipolesis, confirming a diagnosis of RDD. The condition is known to be self-limiting. However, evidence from literature and our case management shows that medical therapy can hasten remission in pediatric cases., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Published
2024
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4. Mitigating antimicrobial resistance (AMR) using implementation research: a development funder's approach.

Author

Khurana MP, Essack S, Zoubiane G, Sreenivasan N, Cordoba GC, Westwood E, Dalsgaard A, Mdegela RH, Mpundu M, Scotini R, Matondo AB, Mzula A, Chanishvili N, Gogebashvili D, Beruashvili M, Tsereteli M, Sooronbaev T, Kjærgaard J, Bloch J, Isaeva E, Mainda G, Muuka G, Mudenda NB, Goma FY, Chu DH, Chanda D, Chirwa U, Yamba K, Kapolowe K, Fwoloshi S, Mwenge L, and Skov R

Abstract

Despite the escalating burden of antimicrobial resistance (AMR), the global response has not sufficiently matched the scale and scope of the issue, especially in low- and middle-income countries (LMICs). While many countries have adopted national action plans to combat AMR, their implementation has lagged due to resource constraints, dysfunctional multisectoral coordination mechanisms and, importantly, an under-recognized lack of technical capacity to adapt evidence-based AMR mitigation interventions to local contexts. AMR interventions should be tailored, context-specific, cost-effective and sustainable. The implementation and subsequent scale-up of these interventions require multidisciplinary intervention-implementation research (IIR). IIR involves both quantitative and qualitative approaches, occurs across a three-phase continuum (proof of concept, proof of implementation and informing scale-up), and across four context domains (inner setting, outer setting, stakeholders and the implementation process). We describe the theoretical underpinnings of implementation research (IR), its various components, and how to construct different IR strategies to facilitate sustainable uptake of AMR interventions. Additionally, we provide real-world examples of AMR strategies and interventions to demonstrate these principles in practice. IR provides a practical framework to implement evidence-based and sustainable AMR mitigation interventions., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Published
2023
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5. Effect of systematic tuberculosis detection on mortality in young children with severe pneumonia in countries with high incidence of tuberculosis: a stepped-wedge cluster-randomised trial.

Author

Marcy O, Wobudeya E, Font H, Vessière A, Chabala C, Khosa C, Taguebue JV, Moh R, Mwanga-Amumpaire J, Lounnas M, Mulenga V, Mavale S, Chilundo J, Rego D, Nduna B, Shankalala P, Chirwa U, De Lauzanne A, Dim B, Tiogouo Ngouana E, Folquet Amorrissani M, Cisse L, Amon Tanoh Dick F, Komena EA, Kwedi Nolna S, Businge G, Natukunda N, Cumbe S, Mbekeka P, Kim A, Kheang C, Pol S, Maleche-Obimbo E, Seddon JA, Mao TE, Graham SM, Delacourt C, Borand L, and Bonnet M

Subjects
Humans, Child, Child, Preschool, Incidence, Sensitivity and Specificity, Sputum microbiology, Mycobacterium tuberculosis, Tuberculosis diagnosis
Abstract

Background: Tuberculosis diagnosis might be delayed or missed in children with severe pneumonia because this diagnosis is usually only considered in cases of prolonged symptoms or antibiotic failure. Systematic tuberculosis detection at hospital admission could increase case detection and reduce mortality., Methods: We did a stepped-wedge cluster-randomised trial in 16 hospitals from six countries (Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Uganda, and Zambia) with high incidence of tuberculosis. Children younger than 5 years with WHO-defined severe pneumonia received either the standard of care (control group) or standard of care plus Xpert MTB/RIF Ultra (Xpert Ultra; Cepheid, Sunnyvale, CA, USA) on nasopharyngeal aspirate and stool samples (intervention group). Clusters (hospitals) were progressively switched from control to intervention at 5-week intervals, using a computer-generated random sequence, stratified on incidence rate of tuberculosis at country level, and masked to teams until 5 weeks before switch. We assessed the effect of the intervention on primary (12-week all-cause mortality) and secondary (including tuberculosis diagnosis) outcomes, using generalised linear mixed models. The primary analysis was by intention to treat. We described outcomes in children with severe acute malnutrition in a post hoc analysis. This study is registered with ClinicalTrials.gov (NCT03831906) and the Pan African Clinical Trial Registry (PACTR202101615120643)., Findings: From March 21, 2019, to March 30, 2021, we enrolled 1401 children in the control group and 1169 children in the intervention group. In the intervention group, 1140 (97·5%) children had nasopharyngeal aspirates and 942 (80·6%) had their stool collected; 24 (2·1%) had positive Xpert Ultra. At 12 weeks, 110 (7·9%) children in the control group and 91 (7·8%) children in the intervention group had died (adjusted odds ratio [OR] 0·986, 95% CI 0·597-1·630, p=0·957), and 74 (5·3%) children in the control group and 88 (7·5%) children in the intervention group had tuberculosis diagnosed (adjusted OR 1·238, 95% CI 0·696-2·202, p=0·467). In children with severe acute malnutrition, 57 (23·8%) of 240 children in the control group and 53 (17·8%) of 297 children in the intervention group died, and 36 (15·0%) of 240 children in the control group and 56 (18·9%) of 297 children in the intervention group were diagnosed with tuberculosis. The main adverse events associated with nasopharyngeal aspirates were samples with blood in 312 (27·3%) of 1147 children with nasopharyngeal aspirates attempted, dyspnoea or SpO 2 less than 95% in 134 (11·4%) of children, and transient respiratory distress or SpO 2 less than 90% in 59 (5·2%) children. There was no serious adverse event related to nasopharyngeal aspirates reported during the trial., Interpretation: Systematic molecular tuberculosis detection at hospital admission did not reduce mortality in children with severe pneumonia. High treatment and microbiological confirmation rates support more systematic use of Xpert Ultra in this group, notably in children with severe acute malnutrition., Funding: Unitaid and L'Initiative., Translation: For the French translation of the abstract see Supplementary Materials section., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Published
2023
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