Prevalence rate of undiagnosed tuberculosis in the community in Ethiopia from 2001 to 2014: systematic review and meta-analysis

Abstract

Background: In Ethiopia individual report indicated nearly 30% of incident cases of tuberculosis remained undiagnosed. Therefore, this systematic review and meta-analysis was aimed to determine the pooled prevalence rate of undiagnosed smear positive pulmonary tuberculosis (PTB) using community based studies published in Ethiopia. Methods: MEDLINE/PubMed, 'Cochrane' library, and Google scholar databases were searched, and reference list of studies on tuberculosis in Ethiopia were reviewed. We used table to present descriptive information of original studies and quantitative results were presented in forest plots. The Cochrane Q test and I 2 test statistic were used to test heterogeneity across studies. The Pooled prevalence and point estimates of undiagnosed smear positive PTB were computed by a random effects model. Results: From the nine studies included in the analysis, the pooled prevalence rate and point estimate of undiagnosed smear positive PTB was 0.11%(95% CI, 0.06-013%, p < 0.001) and 79.8/100,000(95% CI; 56.3-112.8) respectively. Pooled prevalence rate and point estimate of bacteriologically confirmed PTB were 0.17%(95%CI; 0.13-0.22%, P < 0.001) and 191/100000(95% CI; 141.3-258) respectively. The ratio of active to passive case detection was 2.3(95% CI, 0.42-4.1). Pooled prevalence rate of presumptive PTB was 2.7%(95% CI; 1.3-5.3%). Conclusions: The analysis revealed that the magnitude of undiagnosed smear positive PTB cases in the community is high in Ethiopia. This indicated the ongoing transmission of tuberculosis in community due to missed infectious cases. Active tuberculosis finding in the community should be strengthened in Ethiopia. Trial registration: 140611.

Increasing smear positive tuberculosis detection using a clinical score – A stepped wedge multicenter trial from Africa

“…The effect of the intervention was pronounced in Gondar where the use of the TBscore as diagnostic trigger increased the number of SP PTB patients 4-fold. This is in line with findings from South Africa (Kweza et al, 2018) and Ethiopia (Arega et al, 2019) where 71% and 67% bacteriological confirmed TB patients, respectively, went undetected when seeking health care for TB related symptoms. Both Guinea-Bissau and Ethiopia have high case detection gaps which have not improved as expected in the recent years (WHO, 2019).…”

“…Although the well-known criterion "cough for more than two weeks" is outdated and it is recommended to be as inclusive as possible (WHO, 2011a), it still is this symptom the healthcare workers are brought up with and remember when they screen for TB. It is the most frequently used cut off for when to suspect TB (Arega et al, 2019), even though it results in missed cases (Harries and Kumar, 2018, Kweza et al, 2018.…”

Impact of early chest radiography on delay in pulmonary tuberculosis case notification in Ethiopia

“…[ 6 ] A third of TB cases have been missed in Ethiopia [ 7 ] and a couple of undiagnosed TB cases are identified in the community that hiddenly transmit the disease. [ 8 ]…”

Missed Tuberculosis Investigations and Associated Factors in Patients with Symptoms Indicative of Tuberculosis at Public Health Institutions in Northwest Ethiopia: The Application of a Negative Binomial Model

“…This figure is slightly lower than findings from the previous Ethiopian studies, which included 11 TB cases from the Kaffa zone, 17 10 TB cases from Oromiya region hospitals, 15 and 11 TB cases from systematic and meta-analysis studies. 27 Similarly, it is lower than findings from Ghana 28 that reported 27 missed TB cases from 410 TB suspects and 95 TB cases among 543 TB suspected patients in South Africa. 29 The difference in sputum sample evaluation could be due to the fact that previous studies used GeneXpert, which has higher sensitivity to detect TB cases than sputum smear evaluation.…”