Microscopic examination and smear negative pulmonary tuberculosis in Ethiopia

Keflie, Tibebeselassie Seyoum; Ameni, Gobena

doi:10.11604/pamj.2014.19.162.3658

Cited by 15 publications

(9 citation statements)

References 17 publications

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“…Based on the national TB prevalence survey in Ethiopia, 57 % of smear-negative cases were culture positive [31]. Another study in Ethiopia documented that 47 % smear-negative cases were culture positive [32]. This may suggest that availing better diagnostic tools for health institutions, particularly at health centers where majority of the TB patients first seek care expedites timely diagnosis and treatment of PTB cases.…”

Section: Discussionmentioning

confidence: 99%

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

2016

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BackgroundTuberculosis (TB) is a major public health concern in the developing world. Early diagnosis and prompt initiation of treatment is essential for effective TB control. The aim of this study was to determine the length and analyze associated factors of patients’ and health system’s delays in the diagnosis and treatment of new pulmonary TB (PTB) patients.MethodsA cross-sectional study was conducted in 30 randomly selected public health facilities in West Gojjam Zone, Amhara Region, Ethiopia. Newly diagnosed PTB patients who were ≥15 years of age were consecutively enrolled in the study. Patients’ delay (the time period from onset of TB symptoms to first presentation to a formal health provider) and health system’s delay (the time period from first presentation to a formal health provider to first start of TB treatment) were measured. Median patients’ and health system’s delays were calculated. Mixed effect logistic regression was used to analyze predictors of patients’ and health system’s delays.ResultsSeven hundred six patients were enrolled in the study. The median patients’ delay was 18 days (interquartile range [IQR]: 8–34 days) and the median health system’s delay was 22 days (IQR: 4–88 days). Poor knowledge of TB (adjusted odds ratio [AOR], 2.33; 95 % confidence interval [CI], 1.34–4.05), first visit to non-formal health provider (AOR, 47.56; 95 % CI, 26.31–85.99), self-treatment (AOR, 10.11; 95 % CI, 4.53–22.56) and patients’ age (≥45 years) (AOR, 2.99; 95 % CI, 1.14–7.81) were independent predictors of patients’ delay. Smear-negative TB (AOR, 1.88; 95 % CI, 1.32–2.68) and first visit to public health centers (AOR, 2.22; 95 % CI, 1.52–3.25) and health posts (AOR, 5.86; 95 % CI, 1.40–24.39) were found to be independent predictors of health system’s delay.ConclusionsThe health system’s delay in this study was long and contributed more than 50 % of the total delay. Better TB diagnostic tools to complement sputum smear microscopy are needed to early diagnose PTB cases at peripheral health facilities. In addition, due emphasis should be given to increase public awareness about symptoms and consequences of TB disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1995-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

2016

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“…In paediatric population many studies have demonstrated that Xpert assay is highly sensitive and specific in diagnosing for both pulmonary and extrapulmonary TB [7,8,9,10]. Hence this study is aimed to establish the diagnostic accuracy of clinically diagnosed presumptive childhood tuberculosis of CBNAAT versus liquid culture.…”

Section: Original Research Articlementioning

confidence: 99%

Diagnostic accuracy of CBNAAT (Gene-Xpert) Vs liquid culture in clinically diagnosed presumptive childhood tuberculosis admitted in Pt. J.N.M. Medical College & Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur (C.G.)

et al. 2019

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Background: Paediatric tuberculosis comprises 10% of all tuberculosis in developing countries. Smear microscopy is diagnostic for Pulmonary TB whereas for extra-pulmonary TB, CBNAAT (Gene-Xpert) and liquid-culture are available choices. Objectives: To establish the comparative diagnostic efficacy of CBNAAT and Liquid-culture in clinically presumptive childhood Tuberculosis. Outcome: Assess sensitivity and specificity of CBNAAT Vs Liquid-culture in clinically diagnosed presumptive childhood tuberculosis. Material & Method: After approval from institutional ethical committee this Cross-sectional study was performed in department of paediatrics Pt. J. N. M. Medical College, Raipur C.G. Total 97 paediatric presumptive TB cases were enrolled for systematic screening from June-2017 to July-2018. Samples were collected and analysed by CBNAAT and liquid-culture. Data for Diagnostic efficacy of both techniques were analysed with appropriate statistical method. Results: Among study subject group 41.2% belongs to 11-15 agegroup and 53.6% were female. Majority of them belongs to joint family (81.4%) and low-socioeconomic (85.6%) status. Among 97 presumptive cases CBNAAT was positive in 24.7% whereas liquid-culture was positive in 22.7%. CBNNAT has sensitivity (100%) and specificity (98.61%) when compared with liquid-culture as gold-standard. It has 95.65% positive and 100% negative predictive values. CBNAAT had 100% of sensitivity and specificity in diagnosis of abdominal-tuberculosis and TB-meningitis. In Pulmonary-TB diagnosis its specificity reduced to 98%. Conclusion: CBNAAT is equally efficacious diagnostic tool to diagnose clinically presumptive TB cases and it should be used in public health system for early diagnosis of paediatric tuberculosis.

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“…Accordingly, smear-negative cases contributed 20% of the smear-positive cases. In the current study however, the contribution of smear-negative culture positive cases were estimated based on evidence from Ethiopia [ 14 , 15 ], and the result indicates that smear-negative culture positive cases contributed 15.9% of infectious person days to the infectious pool.…”

Section: Discussionmentioning

confidence: 86%

“…While in the current study, we computed the median TB management time for smear-negative cases from the data collected in this study. We also estimated the proportion of smear-negative culture positive cases based on the local evidence [ 14 , 15 ]. In the previous study, smear-negative category accounted for 12.3% of the infectious pool while in the current study accounted for 15.9% of the size of the infectious pool making a difference of 3.6% between the previous and the current studies.…”

Section: Discussionmentioning

confidence: 99%

“…The national TB prevalence survey in Ethiopia indicated that 57% of smear-negative cases were culture positive. Another study in Ethiopia revealed that 47% smear-negative cases were culture positive [ 14 , 15 ]. Based on these facts, we used an average of these two studies (52%) to estimate the number of smear-negative culture positive cases in our study.…”

Section: Methodsmentioning

confidence: 99%

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Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia

2017

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BackgroundMeasuring the size of the infectious pool of tuberculosis (TB) is essential to understand the burden and monitor trends of TB control program performance. This study applied the concept of TB management time to estimate and compare the size of the TB infectious pool between 2009 and 2014 in West Gojjam Zone of Amhara Region, Ethiopia.MethodsNew sputum smear-positive and smear-negative pulmonary TB (PTB) and retreatment cases who attended 30 randomly selected public health facilities in West Gojjam Zone from October 2013 to October 2014 were consecutively enrolled in the study. In order to determine the infectious period, the TB management time (number of days from the onset of cough until start of anti-TB treatment) was computed for each patient category. The number of undiagnosed TB cases was estimated and hence the TB management time for the undiagnosed category was calculated. The total size of the TB infectious pool during the study period for the study zone was estimated as the annual number of infectious person days.ResultsNew smear-positive and smear-negative PTB cases contributed 25,050 and 12,931 infectious person days per year to the TB infectious pool, respectively. The retreatment and presently undiagnosed cases contributed 8840 and 34,310 infectious person days per year, respectively. The total size of the TB infectious pool in West Gojjam Zone during the study period was estimated at 81,131 infectious person days per year or 3405 infectious person days per 100,000 population per year. Compared to a similar study done in 2009 in the study area, the current study showed reduction of the TB infectious pool by 244,279 infectious person days.Conclusions TB management time is a simple and practical tool that may help to estimate and compare the changes in the size of the TB infectious pool at local level. It may also be used as an indicator to monitor the changes in TB control program performance.Electronic supplementary materialThe online version of this article (10.1186/s40249-017-0371-6) contains supplementary material, which is available to authorized users.

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Microscopic examination and smear negative pulmonary tuberculosis in Ethiopia

Cited by 15 publications

References 17 publications

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

Patients’ and health system’s delays in the diagnosis and treatment of new pulmonary tuberculosis patients in West Gojjam Zone, Northwest Ethiopia: a cross-sectional study

Diagnostic accuracy of CBNAAT (Gene-Xpert) Vs liquid culture in clinically diagnosed presumptive childhood tuberculosis admitted in Pt. J.N.M. Medical College & Dr. Bhim Rao Ambedkar Memorial Hospital, Raipur (C.G.)

Applying tuberculosis management time to measure the tuberculosis infectious pool at a local level in Ethiopia

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