Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis.
Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis.
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作者：
在撒哈拉以南非洲，许多被诊断为结核病的患者后来没有被诊断为结核病。这代表了患者的比例，以及他们的替代诊断，以前没有系统地审查过。我们检索了从成立到2020年4月27日的四个数据库，没有语言限制。我们纳入了来自撒哈拉以南非洲的所有成人肺结核诊断研究，不包括病例系列和住院研究。我们提取了推定为结核病的患者的比例，这些患者后来没有被诊断为结核病，并接受了任何替代诊断。我们进行了随机效应荟萃分析，以获得按被动病例发现和主动病例发现进行分层的合并估计。我们的搜索确定了1799项研究，其中18项研究(2002-2019年)涉及来自10个非洲国家的14527名参与者。在被动研究中，推定为结核病的患者随后未被诊断为结核病的比例为48.5%(95%可信区间39.0~58.0)，在积极病例发现研究中为92.8%(95%可信区间85.0~96.7)。这一比例随着临床诊断的结核病病例数量的减少而增加。55%的研究记录了肺结核病史，18个研究中只有5个报告了任何替代诊断。在撒哈拉以南非洲，所有推定为结核病的患者中，近一半没有活动性结核病的最终诊断。当使用积极的病例发现策略时，这一比例可能会更高。人们对这些患者的医疗保健需求知之甚少。需要进行研究，以更好地描述这些患者群体的特征，并规划满足他们需求的卫生系统解决方案。CRD42018100004。
Many patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed. We searched four databases from inception to 27 April 2020, without language restrictions. We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random effects meta-analysis to obtain pooled estimates stratified by passive and active case finding. Our search identified 1799 studies, of which 18 studies (2002–2019) with 14 527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 39.0 to 58.0) in passive and 92.8% (95% CI 85.0 to 96.7) in active case-finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. A history of tuberculosis was documented in 55% of studies, with just five out of 18 reporting any alternative diagnoses. Nearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case-finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs. CRD42018100004.
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DOI：
10.1016/s2468-2667(21)00033-5
发表时间：
2021-05
期刊：
The Lancet. Public health
影响因子：
--
作者：
Burke RM;Nliwasa M;Feasey HRA;Chaisson LH;Golub JE;Naufal F;Shapiro AE;Ruperez M;Telisinghe L;Ayles H;Corbett EL;MacPherson P
通讯作者：
MacPherson P
DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
影响因子：
3.7
作者：
Hamusse S;Demissie M;Teshome D;Hassen MS;Lindtjørn B
通讯作者：
Lindtjørn B
影响因子：
--
作者：
Bruchfeld, J;Aderaye, G;Lindquist, L
通讯作者：
Lindquist, L
影响因子：
3.7
作者：
Deribew, Amare;Abebe, Gemeda;Colebunders, Robert
通讯作者：
Colebunders, Robert