Abstract
BackgroundEvery year around 4 million people with tuberculosis (TB) are not detected. Thus may not get the medical care that they need and deserve from their respective health systems. Ethiopia is included in the 12 countries who contribute 75% of the globally estimated “missed” cases. This study assessed if there are missed Pulmonary TB (PTB) cases among inpatients of a large referral hospital in Ethiopia.MethodA cross sectional survey was conducted in the general medical wards of the large referral hospital from June to August 2015. Inpatients not diagnosed with TB were screened for TB symptoms and requested to submit a morning sputum sample for smear microscopy and molecular testing by GeneXpert MTB/RIF assay. The results of the symptom screening, smear and GeneXpert testing were analyzed as the main outcome characteristics for “missed” PTB cases.ResultOver the 3-month period, 300 inpatients were evaluated for TB. The patients median age was 38 years (IQR 26–51.5), 41% were female, median reported duration of sickness before admission was 30 days (IQR 14–240), and median body mass index (BMI) was 21.5 (IQR 20–22.67). HIV status was documented for 198/300 (66%) of patients, 37 (18.7%) were found to be HIV positive, with a median CD4 count of 176 (IQR 52–400). All 300 inpatients submitted a sputum sample and 10 (3.3%) were found to be GeneXpert MTB positive, with 4/10 also being smear positive. All GeneXpert positive inpatients reported having a cough of > 2 weeks duration. Eight had at least 3 common symptoms of TB (i.e. cough, fever, weight loss or night sweat). Co-morbidity with Diabetes Mellitus (DM) and HIV was found in 1/10 and 4/10 cases respectively.ConclusionBacteriological confirmed TB cases were found to have been “missed” amongst the general medical ward inpatients in the hospital. The identified TB cases all reported typical signs and symptoms of TB. Basic clinical practices were not being followed (i.e. history taking/documentation and requesting of appropriate laboratory tests) by the attending health care workers (HCWs) in the hospital. The index of suspicion for TB disease needs to improve and the use of more sensitive technologies, such as GeneXpert could assist the diagnosis of TB. However, the findings of the study need to be investigated in other hospital settings in Ethiopia.
Highlights
About 4 million people with tuberculosis (TB) are missed each year by the health system
In total, the data capture form was filled and a morning sputum sample collected for microscopy and GeneXpert testing for 300 inpatients
Our study suggests TB cases are being “missed” in the general medical inpatient wards in hospitals in Ethiopia
Summary
About 4 million people with tuberculosis (TB) are missed each year by the health system. Of these missed cases 75% are in 12 countries and Ethiopia is one of them [1]. The directly observed therapy, short-course strategy (DOTS) has been scaled up globally between 2000 and 2014, with 43 million lives saved, 1.5 million people still die every year from TB [1]. Most of these deaths reflect diagnosis that is either delayed, missed, or never attempted [1]. This study assessed if there are missed Pulmonary TB (PTB) cases among inpatients of a large referral hospital in Ethiopia
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