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3. Assessing tuberculosis control priorities in high-burden settings: a modelling approach

Author

Vesga, Juan F, Hallett, Timothy B, Reid, Michael J A, Sachdeva, Kuldeep Singh, Rao, Raghuram, Khaparde, Sunil, Dave, Paresh, Rade, Kiran, Kamene, Maureen, Omesa, Eunice, Masini, Enos, Omale, Newton, Onyango, Elizabeth, Owiti, Philip, Karanja, Muthoni, Kiplimo, Richard, Alexandru, Sofia, Vilc, Valentina, Crudu, Valeriu, Bivol, Stela, Celan, Cristina, and Arinaminpathy, Nimalan

Published
2019
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4. Health system perspective costing of TB, HIV and dysglycaemia (prediabetes and diabetes) in Kenya and a minimum care package policy proposal: the THANDYS study

Author

Kerama, Cheryl Zawadi, primary, Mureithi, Marianne, additional, Njenga, Erick, additional, Vezi, Brian, additional, Kamuyu, Rosemary, additional, Kidake, Victor, additional, Kiplimo, Ann, additional, Mulera, Sarah, additional, Mollen, Stella, additional, Chiboli, Brenda, additional, Ronoh, Aiban, additional, Kirathe, Dickson, additional, Kiplimo, Richard, additional, Anzala, Omu, additional, and Ong’ang’o, Jane, additional

Published
2023
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6. Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya

Author

Meme, Helen, primary, Amukoye, Evans, additional, Bowyer, Cressida, additional, Chakaya, Jeremiah, additional, Dobson, Ruaraidh, additional, Fuld, Jonathan, additional, Gray, Cindy M, additional, Kiplimo, Richard, additional, Lesosky, Maia, additional, Mortimer, Kevin, additional, Ndombi, Amos, additional, Obasi, Angela, additional, Orina, Fred, additional, Quint, Jennifer K, additional, Semple, Sean, additional, West, Sarah E, additional, Zurba, Lindsey, additional, and Devereux, Graham, additional

Published
2023
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7. Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

Author

Meme, Hellen, primary, Amukoye, Evans, additional, Bowyer, Cressida, additional, Chakaya, Jeremiah, additional, Das, Darpan, additional, Dobson, Ruaraidh, additional, Dragosits, Ulrike, additional, Fuld, Jonathan, additional, Gray, Cindy, additional, Hahn, Matthew, additional, Kiplimo, Richard, additional, Lesosky, Maia, additional, Loh, Miranda M, additional, McKendree, Jean, additional, Mortimer, Kevin, additional, Ndombi, Amos, additional, Netter, Louis, additional, Obasi, Angela, additional, Orina, Fred, additional, Pearson, Clare, additional, Price, Heather, additional, Quint, Jennifer K, additional, Semple, Sean, additional, Twigg, Marsailidh, additional, Waelde, Charlotte, additional, Walnycki, Anna, additional, Warwick, Melaneia, additional, Wendler, Jana, additional, West, Sarah E, additional, Wilson, Michael, additional, Zurba, Lindsay, additional, and Devereux, Graham, additional

Published
2023
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8. Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

Author

Meme, Hellen, Amukoye, Evans, Bowyer, Cressida, Chakaya, Jeremiah, Das, Darpan, Dobson, Ruaraidh, Dragosits, Ulrike, Fuld, Jonathan, Gray, Cindy, Hahn, Matthew, Kiplimo, Richard, Lesosky, Maia, Loh, Miranda M, McKendree, Jean, Mortimer, Kevin, Ndombi, Amos, Netter, Louis, Obasi, Angela, Orina, Fred, Pearson, Clare, Price, Heather, Quint, Jennifer K, Semple, Sean, Twigg, Marsailidh, Waelde, Charlotte, Walnycki, Anna, Warwick, Melaneia, Wendler, Jana, West, Sarah E, Wilson, Michael, Zurba, Lindsay, Devereux, Graham, Amukoye, Evans [0000-0003-0683-0585], Pearson, Clare [0000-0003-3274-1586], Quint, Jennifer K [0000-0003-0149-4869], and Apollo - University of Cambridge Repository

Subjects
asthma epidemiology, asthma, paediatric asthma
Abstract

BACKGROUND: Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. METHODS: Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. RESULTS: 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, 'current wheeze' (9.5% vs 6.4%, p=0.007) and 'trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to 'vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. CONCLUSION: Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.

Published
2023

12. ‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Author

Mungai, Brenda Nyambura, primary, Joekes, Elizabeth, additional, Masini, Enos, additional, Obasi, Angela, additional, Manduku, Veronica, additional, Mugi, Beatrice, additional, Ong’angò, Jane, additional, Kirathe, Dickson, additional, Kiplimo, Richard, additional, Sitienei, Joseph, additional, Oronje, Rose, additional, Morton, Ben, additional, Squire, Stephen Bertel, additional, and MacPherson, Peter, additional

Published
2021
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14. It's not TB but what could it be? Abnormalities on chest X-rays taken during the Kenya National Tuberculosis Prevalence Survey

Author

Mungai, Brenda Nyambura, primary, Joekes, Elizabeth, additional, Masini, Enos, additional, Obasi, Angela, additional, Manduku, Veronica, additional, Mugi, Beatrice, additional, Onǵanǵo, Jane, additional, Kirathe, Dickson, additional, Kiplimo, Richard, additional, Sitienei, Joseph, additional, Oronje, Rose, additional, Morton, Ben, additional, Squire, Stephen Bertel, additional, and MacPherson, Peter, additional

Published
2020
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15. Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya

Author

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

Published
2018
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16. Accuracy of computer-aided chest X-ray in community-based tuberculosis screening: Lessons from the 2016 Kenya National Tuberculosis Prevalence Survey.

Author

Mungai B, Ong'angò J, Ku CC, Henrion MYR, Morton B, Joekes E, Onyango E, Kiplimo R, Kirathe D, Masini E, Sitienei J, Manduku V, Mugi B, Squire SB, and MacPherson P

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., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Mungai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2022
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