A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda

Abstract

Background The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread. Method A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done. Results Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 ( p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) ( p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 ( p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 ( p = 0.001) with an improvement in cure rate from 52.3% to 62% ( p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% ( p = 0.013). Conclusion The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.

Trends of notification rates and treatment outcomes of tuberculosis cases with and without HIV co-infection in eight rural districts of Uganda (2015 – 2019)

“…In Uganda, the incidence of TB has dropped by only -1% between 2015 – 2019 [ 1 ]. This reduction is small and likely to stem from a reduction of TB incidence in urban settings [ 26 – 28 ]. WHO has recently redesignated Uganda as a TB high-burdened country [ 29 ].…”

Osteopontin and malaria: no direct effect on parasite growth, but correlation with P. falciparum-specific B cells and BAFF in a malaria endemic area

“…The OPN concentrations and variations in OPN concentration in infants did not change when linear mixed models were used to adjust for OPN concentrations in corresponding mothers, supporting the conclusion that the source of OPN in cord blood is either the fetus itself or that it is produced in the placenta [ 44 ], and that OPN is not transferred from the mother. Since there was no difference in OPN concentrations in the mothers between delivery and 9 months, this indicates that normal pregnancies do not induce any major changes in production of OPN, even in an area where malaria and several other infectious diseases are relatively common [ 45 , 46 ].…”

Patient characteristics associated with different types of prison TB: an epidemiological analysis of 921 TB cases diagnosed at an Ethiopian prison

“…These findings may suggest lack of timely diagnosis and underutilization of medical services among this group, as 80% of the microbiologically confirmed cases in our study had a positive sputum smear result. Hence, control strategies should be focused towards these younger inmates that are presumably more likely to spread the infection, as sputum positive patients tend to be more infectious compared to only culture positive patients [15,16]. We chose to not discredit observed effect estimates in this study solely based on P value threshold while also acknowledging the associated uncertainty because absence of statistical significance alone does not prove the null hypothesis [17].…”