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Neighbourhood prevalence-to-notification ratios for adult bacteriologically-confirmed tuberculosis reveals hotspots of underdiagnosis in Blantyre, Malawi.
Khundi, McEwen; Carpenter, James R; Corbett, Elizabeth L; Feasey, Helena R A; Soko, Rebecca Nzawa; Nliwasa, Marriott; Twabi, Hussein; Chiume, Lingstone; Burke, Rachael M; Horton, Katherine C; Dodd, Peter J; Cohen, Ted; MacPherson, Peter.
  • Khundi M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Carpenter JR; London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Corbett EL; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Feasey HRA; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Soko RN; London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Nliwasa M; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Twabi H; London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Chiume L; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Burke RM; London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Horton KC; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  • Dodd PJ; Helse Nord TB Initiative, College of Medicine, University of Malawi, Zomba, Malawi.
  • Cohen T; Helse Nord TB Initiative, College of Medicine, University of Malawi, Zomba, Malawi.
  • MacPherson P; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
PLoS One ; 17(5): e0268749, 2022.
Article in English | MEDLINE | ID: covidwho-1933289
ABSTRACT
Local information is needed to guide targeted interventions for respiratory infections such as tuberculosis (TB). Case notification rates (CNRs) are readily available, but systematically underestimate true disease burden in neighbourhoods with high diagnostic access barriers. We explored a novel approach, adjusting CNRs for under-notification (PN ratio) using neighbourhood-level predictors of TB prevalence-to-notification ratios. We analysed data from 1) a citywide routine TB surveillance system including geolocation, confirmatory mycobacteriology, and clinical and demographic characteristics of all registering TB patients in Blantyre, Malawi during 2015-19, and 2) an adult TB prevalence survey done in 2019. In the prevalence survey, consenting adults from randomly selected households in 72 neighbourhoods had symptom-plus-chest X-ray screening, confirmed with sputum smear microscopy, Xpert MTB/Rif and culture. Bayesian multilevel models were used to estimate adjusted neighbourhood prevalence-to-notification ratios, based on summarised posterior draws from fitted adult bacteriologically-confirmed TB CNRs and prevalence. From 2015-19, adult bacteriologically-confirmed CNRs were 131 (479/371,834), 134 (539/415,226), 114 (519/463,707), 56 (283/517,860) and 46 (258/578,377) per 100,000 adults per annum, and 2019 bacteriologically-confirmed prevalence was 215 (29/13,490) per 100,000 adults. Lower educational achievement by household head and neighbourhood distance to TB clinic was negatively associated with CNRs. The mean neighbourhood PN ratio was 4.49 (95% credible interval [CrI] 0.98-11.91), consistent with underdiagnosis of TB, and was most pronounced in informal peri-urban neighbourhoods. Here we have demonstrated a method for the identification of neighbourhoods with high levels of under-diagnosis of TB without the requirement for a prevalence survey; this is important since prevalence surveys are expensive and logistically challenging. If confirmed, this approach may support more efficient and effective targeting of intensified TB and HIV case-finding interventions aiming to accelerate elimination of urban TB.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / Mycobacterium tuberculosis Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Topics: Long Covid Limits: Adult / Humans Country/Region as subject: Africa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0268749

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tuberculosis / Mycobacterium tuberculosis Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Qualitative research / Randomized controlled trials Topics: Long Covid Limits: Adult / Humans Country/Region as subject: Africa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0268749