High urban tuberculosis case notification rates can be misleading: evidence from an urban setting in Ethiopia

Abstract

Background: Tuberculosis (TB) is a major public health problem. Its magnitude the required interventions are affected by changes in socioeconomic condition and urbanization. Ethiopia is among the thirty high burden countries with increasing effort to end TB. We aimed to describe the case notification rate (CNR) for urban tuberculosis (TB) and estimate the percentage of TB patients who are not from the catchment population. Methods: This cross-sectional study used data from TB registers from 2014/15 to 2017/18. We calculated the CNR and treatment success rate for the study area. Results: Of 2892 TB cases registered, 2432 (84%) were from Adama City, while 460 (16%) were from other sites. The total TB CNR (including TB cases from Adama and other sites) was between 153 and 218 per 100,000 population. However, the adjusted TB CNR (excluding cases outside Adama City) was lower, between 135 and 179 per 100,000. Of 1737 TB cases registered, 1652 (95%) were successfully treated. About 16% of TB cases notified contributing to CNR of 32 per 100,000 population is contributed by TB cases coming from outside of Adama city. The CNR of 32 per 100,000 population (ranging from 18 to 46 per 100,000) for Adama City was from the patients that came from the surrounding rural areas who sought care in the town. Conclusion: Although the TB CNR in Adama City was higher than the national CNR, about one-fifth of TB cases came from other sites-which led to overestimating the urban CNR and underestimating the CNR of neighboring areas. TB programs should disaggregate urban TB case notification data by place of residence to accurately identify the proportion of missed cases.

Extrapulmonary Tuberculosis is the Leading Presentation among Hospitalized Children: A Single-Center Experience in a Decade

“…Although many countries report a higher urban load (21,22), our finding could be due to rural areas being underprivileged socioeconomically and in terms of sanitary and health services provided. Alternatively, urban reporting could be over-estimated in some countries, as they report cases by site of notification center rather than by patient residence (23). Regarding the clinical presentation, it was observed that extra-pulmonary TB (EPTB) was more (59.2%) than PTB in this single-center in the ten years from 2009-2018.…”

Bidirectional Relationship Between Tuberculosis and Hypothyroidism: An 18-Year Nationwide Population-Based Longitudinal Cohort Study

“…Second, a modeling study in Taiwan showed that immune senescence played an important role in the age disparity between children and elders, which means patients with latent TB infection have an increased risk of developing TB as they age due to a weakening immune system with older age ( 38 ). Third, TB is a disease whose transmission is favored by the density of urban populations ( 39 ). Taiwan has seen rapid growth in living standards and nationwide coverage of high-quality, publicly funded healthcare services ( 28 ).…”

The economic burden of tuberculosis in Sistan: a high‐risk region in Iran

“…An overview of the statistics in 30 countries with a high TB burden reveals that developing countries might need greater attention. Over 90% of the TB cases and TB-induced deaths occur in developing countries [1,6] probably because poverty plays a major role [7,8]. An estimated 60 billion USD is needed for implementing Stop TB interventions, and the total expenditure needed was 10.1 billion USD for low-to middle-income countries in 2019. available [1].…”