“…This may be influenced by the effects of human immunodeficiency virus (HIV) co-infection in Africa, 12,13 but may also reflect limited access to CXR in the study setting. Our findings in older adults are also similar to those reported recently in India, 15 although the prevalence of smear-positive PTB was higher among older adult patients in India. In a country with limited diagnostic resources such as Vanuatu, it is possible that older patients have a higher prevalence of chronic lung disease with various aetiologies that are potentially misdiagnosed as smear-negative PTB based on negative sputum smears and abnormal CXR.…”