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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High prevalence of pulmonary tuberculosis and inadequate case finding in rural Western Kenya
American Journal of Respiratory and Critical Care Medicine, Volume 183, No. 9, Year 2011
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Description
Rationale: Limited information exists on the prevalence of tuberculosis and adequacy of case finding in African populations with high rates of HIV. Objectives: To estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) and the fraction attributable to HIV, and to evaluate case detection. Methods: Residents aged 15 years and older, from 40 randomly sampled clusters, provided two sputum samples for microscopy; those with chest radiograph abnormalities or symptoms suggestive of PTB provided one additional sputum sample for culture. Measurements and Main Results: PTB was defined by a culture positive for Mycobacterium tuberculosis or two positive smears. Persons with PTB were offered HIV testing and interviewed on care-seeking behavior. We estimated the population-attributable fraction of HIV on prevalent and notified PTB, the patient diagnostic rate, and case detection rate using provincial TB notification data. Among 20,566 participants, 123 had PTB. TB prevalence was 6.0/1,000 (95% con-fidence interval, 4.6-7.4) for all PTB and 2.5/1,000 (1.6-3.4) for smear-positive PTB. Of 101 prevalent TB cases tested, 52 (51%) were HIV infected, and 58 (64%) of 91 cases who were not on treatment and were interviewed had not sought care. Forty-eight percent of prevalent and 65% of notified PTB cases were attributable to HIV. For smear-positive and smear-negative PTB combined, the patient diagnostic rate was 1.4 cases detected per person-year among HIV-infected persons having PTB and 0.6 for those who were HIV uninfected, corresponding to case detection rates of 56 and 65%, respectively. Conclusions: Undiagnosed PTB is common in this community. TB case finding needs improvement, for instance through intensified case finding with mobile smear microscopy services, rigorous HIV testing, and improved diagnosis of smear-negative TB. Copyright © 2011 American Thoracic Society.
Authors & Co-Authors
van 't Hoog, Anna H.
Kenya, Nairobi
Kenya Medical Research Institute
Netherlands, Amsterdam
Universiteit Van Amsterdam
Laserson, Kayla F.
Kenya, Nairobi
Kenya Medical Research Institute
United States, Atlanta
Centers for Disease Control and Prevention
Githui, Willie Abela
Kenya, Nairobi
Kenya Medical Research Institute
Meme, Hellen K.
Kenya, Nairobi
Kenya Medical Research Institute
Agaya, Janet A.
Kenya, Nairobi
Kenya Medical Research Institute
Odeny, Lazarus O.
Kenya, Nairobi
Kenya Medical Research Institute
Muchiri, Benson
Kenya, Nairobi
Kenya Medical Research Institute
Marston, Barbara J.
United States, Atlanta
Centers for Disease Control and Prevention
DeCock, Kevin M.
United States, Atlanta
Centers for Disease Control and Prevention
Borgdorff, Martien Wilhelm
Netherlands, Amsterdam
Universiteit Van Amsterdam
Statistics
Citations: 92
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1164/rccm.201008-1269OC
ISSN:
1073449X
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Locations
Kenya