- Author
-
J.N. Oliwa
- Title
- Unmasking the hidden epidemic
- Subtitle
- The process of theory-guided intervention design to improve case detection of tuberculosis in hospitalised children in Kenya
- Supervisors
-
M. Boele van Hensbroek
M. English - Co-supervisors
-
A.H. van 't Hoog
C. Jones - Award date
- 19 January 2021
- Number of pages
- 239
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Tuberculosis is a leading cause of morbidity and mortality in children. The true burden in children remains unknown- it is a hidden epidemic, mainly due to challenges in diagnosing them. Many remain undetected, a missed opportunity that may cause deaths, from a disease that is curable and preventable. This is particularly unfortunate for those who repeatedly present with suggestive symptoms to health facilities, but do not get assessed for TB (as was the case in over two thirds of cases identified during a recent Kenyan TB prevalence survey). Kenya is one of the high burden TB countries and considerable efforts are being made to provide evidence-based guidelines and new technologies, but gaps remain in TB detection and utilisation of diagnostics, especially in children.
This thesis reports findings from studies that described the epidemiology of childhood TB in Kenya, TB diagnostic practices, the link between TB and pneumonia, the influencers of TB detection, and the development of a theory-driven behaviour change intervention to help improve case detection of TB in children. We demonstrated the need for better understanding of which children may have TB and how they present, development of clearer guidelines to help clinicians better select which patients to investigate and how to respond to negative tests. We also highlighted the need to review the approach to training in terms of goals, content, pedagogy and participants. Recommendations include training champions drawn from recipient hospitals, restructuring work flows, establishing social norms like teamwork and mentorship, and using a collective problem-solving approach. - Persistent Identifier
- https://hdl.handle.net/11245.1/ca695db5-bcd5-48af-9480-3bba8d76558f
- Downloads
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