A fourth study of case-finding methods for pulmonary tuberculosis in Kenya

Aluoch, J A; Edwards, Eric; Stott, H.; Fox, Wallace; Sutherland, Ian

doi:10.1016/0035-9203(82)90240-1

Cited by 21 publications

(9 citation statements)

References 7 publications

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“…World Bank Income Gross National Income per capita: low income (≤$1,005 per yr); lower-middle income ($1,006 to $3,975 per yr); upper-middle income ($3,976 to $12,275 per yr); high income (≥$12,276 per yr) [22]. # : [9, 33, 34, 38, 42–46, 54, 56–58, 60, 62, 63, 66–68, 70–73, 75, 76, 79, 82, 84, 85, 88, 90, 91, 95, 97, 99–101, 234]; ¶ : [30, 31, 111–113, 116, 119, 120, 122, 134, 135, 137, 138, 148–150, 154, 165, 166, 170, 177]. …”

Section: Resultsmentioning

confidence: 99%

Contact investigation for tuberculosis: a systematic review and meta-analysis

et al. 2012

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Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines.We performed a systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB.After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2–4.4%, I2=99.4%), microbiologically proven TB was 1.2% (95% CI 0.9–1.8%, I2=95.9%), and latent TB infection was 51.5% (95% CI 47.1–55.8%, I2=98.9%). The prevalence of TB among household contacts was 3.1% (95% CI 2.1–4.5%, I2=98.8%) and among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4% (95% CI 0.8–12.6%, I2=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1–1.8%, I2=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2–32.4%, I2=99.5%). There was substantial heterogeneity among published studies.Contacts of TB patients are a high-risk group for developing TB, particularly within the first year. Children <5 yrs of age and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.

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Section: Resultsmentioning

confidence: 99%

Contact investigation for tuberculosis: a systematic review and meta-analysis

et al. 2012

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“…Household heads were asked to confirm the presence or absence of a TB suspect in their houses following a screening question posed by the interviewers. A study from Kenya in which a variety of active case finding strategies were applied had shown this method to be highly sensitive in identifying active TB cases in the community [22]. In another study from Kenya that reviewed hospital out-patients, the presence of weight loss and/or cough of between 1 and 12 months was found to be particularly sensitive [23].…”

Section: Discussionmentioning

confidence: 99%

Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: a community-based study

et al. 2009

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BackgroundHealth care seeking is a dynamic process that is influenced by socio-demographic, cultural and other factors. In Ethiopia, there are limited studies regarding the health seeking behaviour of tuberculosis (TB) suspects and TB patients. However, a thorough understanding of patients' motivation and actions is crucial to understanding TB and the treatment of disease. Such insights would conceivably help to reduce delay in diagnosis, improve treatment adherence and thereby reduce transmission of TB in the community. The objective of this study was to describe and analyze health care seeking among TB suspects and pulmonary TB (PTB) cases in a rural district of the Amhara Region in Ethiopia.MethodsStudy kebeles were randomly selected in a cross-sectional study design. House-to-house visits were conducted in which individuals aged 15 years and above in all households of the kebeles were included. Subjects with symptoms suggestive of TB were interviewed about their health seeking behaviour, socio-demographic and clinical factors using a semi-structured questionnaire. Logistics regression analysis was employed to assess associations between the independent and outcome variables.ResultsThe majority, 787 (78%), TB suspects and 33 (82.5%) PTB cases had taken health care actions for symptoms from sources outside their homes. The median delay before the first action was 30 days. In logistics regression, women (AOR 0.8, 95% CI 0.6, 0.9) were found to be less likely to visit a medical health provider than men. Those with a long duration of cough (AOR 1.5, 95% CI 1.03, 2.1) and those with a previous history of TB (AOR 1.5, 95% CI 1.03, 2.3) were more likely to visit a medical health provider compared to those with a shorter duration of cough and with no history of TB.ConclusionThe majority of TB suspects and PTB cases had already taken health care actions for their symptoms at the time of the survey. The availability of a simple and rapid diagnostic TB test for use at the lowest level of health care and the involvement of all health providers in case finding activities are imperative for early TB case detection.

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“…35 Conversely, studies from Kenya on alternative approaches to improving case-finding identified many untreated smear-positive TB cases. [36][37][38][39][40] Yet there appears to be no consensus on the role of active case-finding in low-income settings. Some disparage it for increasing the workload and cost of health services, while others believe it is highly cost-effective in countries with high prevalence, low case-finding, and moderate-to-high treatment completion.…”

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confidence: 99%

TB case-finding in southern Ethiopia

Shargie

Mørkve

Lindtjørn

2006

Bull World Health Organ

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Objective To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB). Methods We randomly allocated 32 rural communities to intervention or control groups. In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects. In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings. Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility. In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities. Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled. Findings In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively. Case-notification rates in all age groups were 124.6/10 5 and 98.1/10 5 person-years, respectively (P = 0.12). The corresponding rates in adults older than 14 years were 207/10 5 and 158/10 5 person-years, respectively (P = 0.09). The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001). Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group. In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12). Conclusion The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting. Both groups had comparable treatment outcomes.Keywords Tuberculosis -prevention and control; Disease notification; Tuberculosis -diagnosis; Ethiopia (source: MeSH, NLM). Mots clés Tuberculose -prévention et contrôle; Notification maladie; Tuberculose -diagnostic; Ethiopie (source: MeSH, INSERM). Palabras clave Tuberculosis -prevención y control; Notificación de enfermedad; Tuberculosis -diagnóstico; Etiopía (fuente: DeCS, BIREME). Voir page 117 le résumé en français. En la página 117 figura un resumen en español.

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A fourth study of case-finding methods for pulmonary tuberculosis in Kenya

Cited by 21 publications

References 7 publications

Contact investigation for tuberculosis: a systematic review and meta-analysis

Contact investigation for tuberculosis: a systematic review and meta-analysis

Health care seeking among pulmonary tuberculosis suspects and patients in rural Ethiopia: a community-based study

TB case-finding in southern Ethiopia

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