Prevalence and Incidence of Smear-Positive Pulmonary Tuberculosis in the Hetosa District of Arsi Zone, Oromia Regional State of Central Ethiopia.
Prevalence and Incidence of Smear-Positive Pulmonary Tuberculosis in the Hetosa District of Arsi Zone, Oromia Regional State of Central Ethiopia.
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DOI：
10.1186/s12879-017-2321-0
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发表时间：
2017-03-16
影响因子：
3.7
通讯作者：
Lindtjørn B
中科院分区：
文献类型：
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作者：
Hamusse S;Demissie M;Teshome D;Hassen MS;Lindtjørn B
埃塞俄比亚的涂阳肺结核（PTB+）和细菌学确诊肺结核（BCTB）的真实的负担尚不清楚。因此，这项以社区为基础的研究的目的是衡量结核病的患病率和发病率在埃塞俄比亚奥罗米亚地区的Hetosa区。首先，对总计33，073名年龄≥ 15岁的个体进行了基于人群的横断面调查，以确定PTB+和BCTB病例的患病率。然后，为了确定发病率，对32，800名在基线调查期间发现没有结核病症状（SSTB）或有结核病症状但细菌学检查结果阴性的人进行了前瞻性随访。我们在基线调查中确定了1，041例推定结核病例，在后续研究中确定了1，468例。每位咳嗽超过两周的参与者都提供了现场和早晨的痰样本，用于抗酸杆菌痰显微镜检查和培养。在基线调查中，确定了43例BCTB病例。其中36例涂片和培养阳性，7例仅培养阳性。然而，在后续研究中，诊断出76例BCTB病例，其中70例被发现是涂片和培养阳性，而6例仅培养阳性。在研究地区，PTB+和BCTB的校正患病率分别为109/10万和132/10万。此外，PTB+和BCTB的发病率分别为214/10万人/年和232/10万人/年。被动与主动发现病例的比例为1：0.96（45/43）。对于通过现有被动病例诊断确定的每一例结核病例，社区中未诊断的传染性结核病例的数量几乎相等（0.96）。TB接触家族史与TB高风险独立相关（TB患病率，AOR，13; 95%CI：6.55-15.33）和（TB发病率，aIRR 4.11，95%CI：2.18-7.77）。在研究地区，涂阳和细菌学证实的结核病病例的流行率和发病率都很高。每有一例涂阳肺结核患者接受治疗，社区中就有几乎相同数量（0.96例）的未发现的细菌学确诊的传染性肺结核病例。社区中未被发现的传染性结核病病例的比例很高，可能是由于短期直接观察治疗（DOTS）在检测70%的传染性结核病病例方面的次优表现，以及在研究地区达到85%的治愈率。结核病接触的家庭史大大增加了发病的风险，有必要改进结核病病例的识别方法，并加强追踪PTB+病例家庭成员之间接触的机制。
The real burden of smear-positive (PTB+) and bacteriologically confirmed tuberculosis (BCTB) in Ethiopia is not known. Thus, the aim of this community-based study was to measure the prevalence and incidence of tuberculosis in the Hetosa District of Oromia Region, Ethiopia. First, a population-based cross-sectional survey was conducted on a total of 33,073 individuals aged ≥ 15 years to determine the prevalence of PTB+ and BCTB cases. Then, in order to determine the incidence, a prospective follow-up was carried out on 32,800 individuals found to be either free from symptoms suggestive of TB (SSTB) during the baseline survey or had symptoms suggestive of TB but yielded negative bacteriological examination results. We identified 1,041 presumptive TB cases at the baseline survey, and 1,468 in the follow-up study. Each participants with cough of more than two weeks were provided spot and morning sputum samples for acid-fast bacilli sputum microscopy and culture. At the baseline survey, 43 BCTB cases were identified. Thirty six of these were both smear- and culture-positive while seven were only culture-positive. In the follow-up study, however, 76 BCTB cases were diagnosed and 70 of these were found to be both smear- and culture-positive while six were culture-positive only. The adjusted prevalence of PTB+ and BCTB in the study area was 109 and 132/100,000 persons, respectively. Moreover, the incidences of PTB+ and BCTB were 214 and 232/100,000 persons per year (py), respectively. The ratio of the passive to active case finding was 1:0.96 (45/43). For every TB case identified through the existing passive case diagnosis, there was an almost equal number (0.96) of undiagnosed infectious TB cases in the community. A family history of TB contact was independently associated with a high risk of TB (TB prevalence, AOR, 13; 95% CI: 6.55–15.33) and (TB incidence, aIRR 4.11, 95% CI: 2.18–7.77). The prevalence and incidence of smear-positive and bacteriologically confirmed TB cases were high in the study area. For every case of smear-positive TB receiving treatment, there was an almost equal (0.96) number of undetected infectious bacteriologically confirmed TB case in the community. The high proportion of undetected infectious TB cases in the community could possibly be due to the sub-optimal performance of Directly Observed Treatment Short-course (DOTS) in detecting 70% of infectious TB cases, as well as attaining a cure rate of 85% in the study area. Family history of TB contact has substantaially increased the risk of developing the disease, and there is a need to improve ways of identifying TB cases and intensify mechanisms of tracing contacts among household members of PTB+ cases.