{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T20:24:23Z","timestamp":1776371063971,"version":"3.51.2"},"reference-count":26,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,11,3]],"date-time":"2024-11-03T00:00:00Z","timestamp":1730592000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Chest x\u2010ray (CXR) plays an important role in childhood tuberculosis (TB) diagnosis, but access to quality CXR remains a major challenge in resource\u2010limited settings. Digital CXR (d\u2010CXR) can solve some image quality issues and facilitate their transfer for quality control. We assess the implementation of introducing d\u2010CXR in 12 district hospitals (DHs) in 2021\u20132022 across Cambodia, Cameroon, Ivory Coast, Mozambique, Sierra Leone and Uganda as part of the TB\u2010speed decentralisation study on childhood TB diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>For digitisation of CXR, digital radiography (DR) plates were setup on existing analogue radiography devices. d\u2010CXR were transferred to an international server at Bordeaux University and downloaded by sites' clinicians for interpretation. We assessed the uptake and performance of CXR services and health care workers' (HCW) perceptions of d\u2010CXR implementation. We used a convergent mixed method approach utilising process data, individual interviews with 113 HCWs involved in performing or interpreting d\u2010CXRs and site support supervision reports.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3104 children with presumptive TB, 1642 (52.9%) had at least one d\u2010CXR, including 1505, 136 and 1 children with one, two and three d\u2010CXRs, respectively, resulting in a total of 1780 d\u2010CXR. Of them, 1773 (99.6%) were of good quality and 1772\/1773 (99.9%) were interpreted by sites' clinicians. One hundred and sixty\u2010four children had no d\u2010CXR performed despite attending the radiography department: 126, 37 and 1 with one, two and three attempts, respectively. d\u2010CXRs were not performed in 21.6% (44\/203) due to connectivity problem between the DR plate captor and the computer. HCW reported good perceptions of d\u2010CXR and of the DR plates provided. The main challenge was the upload to and download from the server of d\u2010CXRs due to limited internet access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>d\u2010CXR using DR plates was feasible at DH level and provided good quality images but required overcoming operational challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.14053","type":"journal-article","created":{"date-parts":[[2024,11,3]],"date-time":"2024-11-03T17:54:08Z","timestamp":1730656448000},"page":"979-989","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Implementation of digital chest radiography for childhood tuberculosis diagnosis at district hospital level in six high tuberculosis burden and resources limited countries"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7368-5923","authenticated-orcid":false,"given":"Bernard Fortune","family":"Melingui","sequence":"first","affiliation":[{"name":"Translational Research on HIV and Endemic and Emerging Infectious Diseases (TransVIHMI) University of Montpellier, National Institute for Health and Medical Research (INSERM), French National Research Institute for Sustainable Development (IRD)  Montpellier France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshi","family":"Basant","sequence":"additional","affiliation":[{"name":"National Institute for Health and Medical Research (INSERM) U 1219, French National Research Institute for Sustainable Development (IRD) University of Bordeaux, Bordeaux Population Health Centre  Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean voisin","family":"Taguebue","sequence":"additional","affiliation":[{"name":"Mother and Child Center Chantal Biya Foundation  Yaounde Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7055-9163","authenticated-orcid":false,"given":"Douglas Mbang","family":"Massom","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmaceutical Science University of Douala  Douala Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etienne","family":"Leroy Terquem","sequence":"additional","affiliation":[{"name":"Fran\u00e7ois Quesnay Hospital\u2014International Pulmonology Support  Mantes la Jolie France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre Yves","family":"Norval","sequence":"additional","affiliation":[{"name":"Technical Assistance for Management (TeAM)  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelica","family":"Salomao","sequence":"additional","affiliation":[{"name":"Independent Public Health Consultant  Maputo Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bunnet","family":"Dim","sequence":"additional","affiliation":[{"name":"Pasteur Institute of Cambodia Epidemiology and Public Health Unit  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chhen Eap","family":"Tek","sequence":"additional","affiliation":[{"name":"Ministry of Public Health National Tuberculosis Program  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7431-5900","authenticated-orcid":false,"given":"Laurence","family":"Borand","sequence":"additional","affiliation":[{"name":"Pasteur Institute of Cambodia Epidemiology and Public Health Unit  Phnom Penh Cambodia"},{"name":"Division of Infectious Diseases Johns Hopkins University School of Medicine  Baltimore Maryland 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Tan","family":"Eang","sequence":"additional","affiliation":[{"name":"Ministry of Health National Center for Tuberculosis and Leprosy (CENAT\/NTP)  Phnom Penh Cambodia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Manhi\u00e7a","sequence":"additional","affiliation":[{"name":"Minist\u00e9rio da Sa\u00fade Programa Nacional de Controlo da Tuberculose  Maputo Mozambique"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6594-6767","authenticated-orcid":false,"given":"Ayeshatu","family":"Mustapha","sequence":"additional","affiliation":[{"name":"Ola During Children Hospital  Freetown Sierra Leone"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Balestre","sequence":"additional","affiliation":[{"name":"National Institute for Health and Medical Research (INSERM) U 1219, French National Research Institute for Sustainable Development (IRD) University of Bordeaux, Bordeaux Population 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Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3350-112X","authenticated-orcid":false,"given":"Olivier","family":"Marcy","sequence":"additional","affiliation":[{"name":"National Institute for Health and Medical Research (INSERM) U 1219, French National Research Institute for Sustainable Development (IRD) University of Bordeaux, Bordeaux Population Health Centre  Bordeaux France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0359-4089","authenticated-orcid":false,"given":"Joanna","family":"Orne\u2010Gliemann","sequence":"additional","affiliation":[{"name":"National Institute for Health and Medical Research (INSERM) U 1219, French National Research Institute for Sustainable Development (IRD) University of Bordeaux, Bordeaux Population Health Centre  Bordeaux 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