Jointly conducted by IRD and INSERM, this research improves the diagnosis of pediatric tuberculosis in resource-limited settings.
Patrick Orikiriza, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2019 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
The diagnosis of tuberculosis in children remains a major challenge, especially in countries with a high prevalence of the disease and HIV. This issue is particularly acute in West Africa, where health systems are often fragile and resources limited. In Uganda, a recent study highlighted the difficulties encountered in identifying this disease in young patients. Traditional diagnostic methods, such as sputum analysis, are often unsuitable for children, who cannot always produce adequate samples. This leads to risky empirical treatments, which can compromise children's health and worsen the epidemiological situation.
Research conducted by Patrick Orikiriza explored promising alternatives, including the use of non-respiratory samples such as stool and urine. This innovative approach could transform the landscape of pediatric tuberculosis diagnosis, making the process more accessible and less traumatic for young patients. Indeed, children are often reluctant to provide sputum, which further complicates diagnosis.
The results of the study are revealing. In the first study, 4.3% of the tested children were confirmed positive for tuberculosis, with an impressive sensitivity of 90.9% for the XpertMTB/RIF test on sputum. However, the stool test showed a sensitivity of only 55.6%. These figures underscore the importance of improving diagnostic methods to avoid over- or under-diagnosis, which can have fatal consequences. Early and accurate diagnosis is crucial, as it allows for prompt treatment initiation and reduces the risk of transmission, particularly in communities where tuberculosis and HIV coexist.
The mortality observed in this study, with 6.9% of children dying within three months of diagnosis, highlights the urgency of rapid and effective action. Treated children exhibited a higher mortality rate, raising questions about the effectiveness of treatments administered without an accurate diagnosis. This also raises ethical concerns, as it is imperative to ensure that children receive appropriate care based on reliable diagnoses. The research also revealed that sample preservation methods do not provide significant benefits, which could influence sample transport and storage practices in resource-limited countries. This means it is essential to rethink sample management protocols to optimize the chances of correct diagnosis.
It is essential to consider how these results can be translated into effective public policies. Policymakers must consider integrating these new diagnostic methods into public health protocols, taking into account the realities of local health systems. For example, training healthcare professionals on the use of these new techniques could be a significant step forward. Collaboration between research institutions and governments is crucial to implement solutions tailored to the needs of vulnerable populations. This could also include partnerships with NGOs and international organizations, which can provide technical and financial support.
In conclusion, Patrick Orikiriza's research paves the way for significant improvements in pediatric tuberculosis diagnosis. The results obtained must be taken into account to develop public health strategies that address the specific challenges faced in countries with a high prevalence of tuberculosis and HIV. By integrating innovative diagnostic methods and strengthening health system capacities, it is possible to reduce child mortality related to tuberculosis and improve the quality of life for affected children. It is imperative that policymakers act quickly to translate these research findings into concrete actions to protect future generations from this devastating disease.
Key Facts
- 4.3% : percentage of children confirmed positive for tuberculosis in the first study.
- 90.9% : sensitivity of the XpertMTB/RIF test on sputum.
- 6.9% : mortality rate observed in children within three months following diagnosis.
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Sources and Access
Patrick Orikiriza. Improving diagnosis of childhood tuberculosis in a high TB-HIV prevalent setting. Human health and pathology. Université Montpellier, 2019. English. ⟨NNT : 2019MONTT026⟩. ⟨tel-02479458⟩