Abstract
BackgroundTuberculosis (TB) remains a major cause of morbidity and mortality in sub-Saharan Africa. This high burden is mainly attributed to low case detection and delayed diagnosis. We aimed to determine the prevalence and predictors of TB among health care-seeking people screened for cough of any duration in Ethiopia.MethodsIn this multicenter cross-sectional study, we screened 195,713 (81.2%) for cough of any duration. We recruited a sample of 1,853 presumptive TB (PTB) cases and assigned them into three groups: group I with cough ≥2 weeks, group II with cough of <2 weeks, and group III pregnant women, patients on antiretroviral therapy, and patients with diabetes. The first two groups underwent chest radiograph (CXR) followed by sputum Xpert MTB/RIF assay or smear microscopy. The third group was exempted from CXR but underwent sputum Xpert MTB/RIF assay or smear microscopy. TB prevalence was calculated across the groups and TB predictors were analyzed using modified Poisson regression to compute adjusted prevalence ratio (aPR) with a 95% confidence interval (CI).ResultsThe overall prevalence of PTB was 16.7% (309/1853). Of the positive cases, 81.2% (251/309) were in group I (cough ≥2 weeks), 14.2% (44/309) in group II (cough of <2), and 4.5% (14/309) in group III (CXR exempted). PTB predictors were age group of 25–34 [aPR = 2.0 (95% CI 1.3–2.8)], history of weight loss [aPR = 1.2 (95% CI 1.1–1.3)], and TB suggestive CXRs [aPR = 41.1 (95% CI 23.2–72.8)].ConclusionThe prevalence of confirmed PTB among routine outpatients was high, and this included those with a low duration of cough who can serve as a source of infection. Screening all patients at outpatient departments who passively report any cough irrespective of duration is important to increase TB case finding and reduce TB transmission and mortality.
Highlights
Prevalence, incidence, and death rates from TB are steadily declining globally [1] because of improved diagnosis and treatment, this is not evident in most countries in subSaharan Africa (SSA) where low case detection due to missed diagnoses or delayed diagnoses, drug risistance and problems with access to high-quality care lead to a higher risk of death, suffering, and catastrophic financial consequences [1]
The prevalence of pulmonary TB cases among people who sought health care with cough of any duration was as high as 309/1853 (16.7%); of which, 298 (95.5%) Pulmonary tuberculosis (PTB) cases were diagnosed at outpatients department (OPD)
The first algorithm is as follows: cough of ≥2 weeks followed by chest X-ray screening with any results that followed with Xpert /AFB smear microscopy, and with this algorithm we found 81.2% PTB cases
Summary
Prevalence, incidence, and death rates from TB are steadily declining globally [1] because of improved diagnosis and treatment, this is not evident in most countries in subSaharan Africa (SSA) where low case detection due to missed diagnoses or delayed diagnoses, drug risistance and problems with access to high-quality care lead to a higher risk of death, suffering, and catastrophic financial consequences [1]. In Kenya, Tanzania, Sudan, Uganda, and Ethiopia, for an individual to be recognized as a presumptive TB patient, they need to report to a health facility with a cough of two or more weeks with or without accompanying symptoms [5, 6], limiting the opportunity to capture those who report less duration of a cough, and women and children attending reproductive and child health (RCH) clinics In these countries, screening for TB has largely been integrated to outpatients department (OPD) and HIV/AIDs clinics [5, 6] but is challenged by high patient load, shortage of manpower and financing, and interruption of laboratory supplies [5, 6].
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