Diagnosis of smear-negative tuberculosis in Nigeria: Do health care workers adhere to the national guidelines? (original) (raw)
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BMC Infectious Diseases, 2013
Background: The 2007 World Health Organization (WHO) guideline to diagnose smear-negative tuberculosis (TB) in HIV-prevalent settings was mainly based on expert advice and therefore requires evaluation in real life situations. Methods: In 2009, this guideline was introduced at the ALERT hospital in Ethiopia. From October 2009 to January 2011, the accuracy of the guideline was evaluated using Mycobacterium tuberculosis culture positivity as reference standard in HIV positive TB suspects. Results: A total of 459 TB suspects were enrolled during the study period; 336 (73.2%) were HIV positive. Acid fast bacilli sputum smear microscopy was done for 74.7% (251/336) HIV positive TB suspects; 94.4% (237/251) were smear negative. A chest X-ray was performed in 92.8% (220/237) and a Mycobacterium tuberculosis culture in 63.7% (151/237). The median TB diagnostic delay for smear negative cases was 3 days (interquartile range 3-4 days). Of the 75 patients diagnosed with smear negative pulmonary TB, 89. 4% (67/75) were diagnosed by chest X-ray, 9.4% (7/75) by culture and 1.3% (1/75) by clinical suspicion only. In 147 smear negative TB suspects Mycobacterium tuberculosis culture and chest X-ray results were available. Among these 147 patients, the sensitivity of the chest X-ray to diagnose smear negative TB in HIV-positive TB suspects was 53.3% (95% CI: 26.7-78.7); the specificity 67.4% (95% CI: 58.7-75.3). Conclusion: The 2007 WHO diagnostic algorithm for the diagnosis of smear negative TB is likely to reduce the diagnostic delay and therefore decrease morbidity and mortality of TB in a HIV prevalent settings like Ethiopia.
TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH, 2016
Background: With an estimated 9.4 million new cases globally, tuberculosis (TB) continues to be a major public health concern 1. Eighty percent of all cases worldwide occur in 22 high-burdens, mainly resource-poor settings. This devastating impact of tuberculosis on vulnerable populations is also driven by its deadly synergy with HIV. Therefore, building capacity and enhancing universal access to rapid and accurate laboratory diagnostics are necessary to control TB and HIV-TB co-infections in resource-limited countries 2. In low income countries (Nigeria inclusive), Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment 3. There is dearth of data on the prevalence of pulmonary tuberculosis (PTB) among patient attendees from individual Institutions and Health Care Facilities performing sputum smear microscopy in Nigeria. This retrospective study will analyze sputum smear microscopy results among pulmonary TB suspected patients presenting to National Hospital Abuja, Federal Capital Territory (FCT), Nigeria. Sputum smear microscopy for Acid Fast Bacilli (AFB) results of new suspected pulmonary TB (Diagnosis) patients and their demographic data comprising age and sex recorded from January 2010 to December 2014 were retrieved from the TB Laboratory Register of the Medical Microbiology department and analyzed. Methods: This hospital based retrospective study analyzed sputum smear microscopy results among pulmonary TB suspected patients presenting to the National Hospital Abuja, Federal Capital Territory, Nigeria. Sputum smear microscopy for Acid Fast Bacilli (AFB) results of new suspected pulmonary TB (Diagnosis) patients and their demographic data comprising age and sex recorded from January 2010 to December 2013 were retrieved from the TB Laboratory Register of the Medical Microbiology department and analyzed. Data processing and statistical analysis were performed using SPSS software (Windows version 16.0). The results were expressed as percentage, with significance at 5%. Results: The overall prevalence of sputum smear positive cases were 17.3% (63 0f 364) and most of the positive patients were within the age range 15-44 years. The highest percentage of TB was seen in the age group of 15-24 years compared with the lowest percentages in the age group below 14 years and above 45 years. A total of 63 (17.3%) suspects were found to have at least one positive. Of these, 56 (88.9% of those with one or more positive smears and 92% of those who fulfilled the case definition) were detected from the first specimen and 7 (11.1%) were positive on the second specimen but not the first. The third specimen did not have any additional diagnostic value for the detection of AFB. Conclusion: The prevalence of sputum smear positive cases of 18.3% increases with age up to the age 44 years. Our result show that examining two sputa smears was sufficient for the detection of AFB in our laboratory. Further research involving different laboratories from all of the six geo-political groups in Nigeria is needed to reassess these findings.
PLoS ONE, 2014
Background: Diagnosis of smear negative pulmonary tuberculosis (SNPTB) is challenging, especially in patients with HIV. The Botswana National Tuberculosis Program (BNTP) guidelines give guidance in diagnosing and treating SNPTB. Patients with chronic cough should be screened for TB by 3 sputum smear investigations. If negative, a chest x-ray (CXR) should be performed. If negative for TB, antimicrobial treatment for other infections should be started. We investigated the clinicians' use of the guidelines in clinical practice. Methods: Data regarding the medical history (coughing period), requested and conducted investigations concerning tuberculosis diagnosis (sputum smear or culture or CXR) or alternative diagnoses (sputum microscopy or blood or sputum culture for diagnosis of other organisms), in SNPTB HIV-positive patients (outpatients and admitted patients) from 2006-2009 in a district hospital in Botswana were extracted from all available hospital medical records. Additionally, a survey was done in all doctors diagnosing SNPTB in this hospital using a self-administered questionnaire with questions regarding the application of the BNTP guidelines in practice. Descriptive analyses of collected data were performed to test the compliance to the guidelines. Results: Data from medical records showed that in 47.0% (132/281) of patients, TB treatment was started without microbiological results from sputum smears. Other methods to rule out or confirm PTB were used in 2.1% (6/281); and 99.6% (280/281) of SNPTB patients had received a CXR. The survey in 7 clinicians found that all always used CXR, and all clinicians requested three sputum results only sometimes. Six out of 7 clinicians started antibiotics before starting TB treatment. Reasons clinicians gave for difficulties in following the guidelines included inability of patients to produce sputum; and laboratory delays in releasing sputum results. Conclusion: Between 2006 and 2009 a high proportion of SNPTB diagnoses in a district hospital in Botswana were not supported by laboratory investigation.
Epidemiology of Smear ‐ Negative Tuberculosis in Ibadan, Nigeria
African Journal of Infectious Diseases, 2013
Inadequate case detection has been identified as one of the reasons for high burden of tuberculosis (TB) in the world especially in poor resourced countries of Africa and Asia. This retrospective laboratory study involving the review of specimens processed at the TB laboratory of the
PLOS ONE
Tuberculosis (TB) is a serious disease of public health concern, mainly in low-and middleincome countries. Most of these countries have challenges in diagnosis and treatment of TB in people with smear-negative pulmonary tuberculosis (SNPTB), which remains a significant public health challenge because of the global burden of the disease. We evaluated the epidemiology and clinical presentation of SNPTB in a cohort of patients with high HIV burden. The study was a cross-sectional study among patients with SNPTB in four major hospitals that care for TB/HIV patients in north-central Nigeria. All patients 18 years and above who were newly diagnosed as SNPTB, or patients with SNPTB who had not taken TB drugs for up to 2 weeks irrespective of their HIV status were recruited. Demographic data (sex, age), smoking status, and medical history (clinical form of TB, symptoms at admission, diagnostic methods, presence of comorbidities, prior TB treatment) were obtained using a semi-structured questionnaire. Detailed clinical examination was also done on all the study subjects. Baseline results of packed cell volume, HIV test and sputum acid fast bacilli done during TB screening were retrieved from the patients' case notes and recorded. Also, the base line Chest X-ray films taken during TB screening were reviewed and reported by two radiologists blinded to each other's reports. The Xpert MTB/RIF tests and sputum culture (using LJ medium) were done in a TB reference laboratory. A total of 150 patients with SNPTB were studied. Majority of the patients were female 93 (62%). The median age of the patients was 36.5 years with greater percentage of the patients within the ages of 25-44 years 92 (61.3%). Twenty-two (14.7%) of the patients had previous TB treatment. History of cigarette smoking was obtained in only 7(4.7%) of the patients while 82 (64.1%) were HIV positive. All the patients had a history of cough for over a period of at least three weeks, while, 27 (18%) reported having hemoptysis. About 87 (58%) had fever and 110 (73.7%) had anemia, while weight loss and night sweat were reported in 98(65.3%) and 82 (54.7%) of the patients respectively. Chest x rays were reported as typical of TB in only 24 (16%) of the patients. Of the 150 sputa sample analyzed, 21/150 (14.0%) and 22/150 (14.7%) where Gene Xpert and
The study had two main broad but related objectives. The first objective was to determine the actual causes of under detection of pulmonary TB cases in the Northern Region of Ghana. Data was collected through administering a structured questionnaire; and collection of sputum samples from the respondents. The second objective was to determine the actual causes of low smear positive rates by assessing the capacity to effectively perform sputum smear microscopy for Acid Fast Bacilli (AFBs) in the district hospitals where the study was conducted. Collection of data here involved the use of a structured checklist for the laboratory and the staff who performed Tb microscopy. In all, 26 laboratory staff who performed Tb microscopy in the study district hospital laboratories were involved. The study lasted for a period of three months. The study revealed that, 41.2% of the study participants did not go to hospital when they fell sick. Out of this figure, 20.4% (21) attributed their inability to do so to poverty, 4.9% (5) to lack of access, 35.9% (37) to stigma, 28.2% (29) to cultural beliefs and 10.6%(11) attributed it to other reasons.
Archives of Community Medicine and Public Health, 2021
Background: Tuberculosis (TB) in the African sub-region, is still a public health problem, heightened by its synergy with HIV. Sputum smear positivity which is diagnostic indicator often gives a lower prevalence of the disease that may be give a false burden of the disease thus leading to varied treatment outcomes that may add to the vicious cycle of the magnitude of the disease. Thus, the prevalence of sputum positivity and co-infection with HIV; trend and treatment outcomes of TB were assessed. Methods: Secondary data of TB patients from 2012 (commencement of TB care at this centre)-2018 at Faith Alive Foundation Jos, a renowned faith-based hospital with approximately with a large monthly patient turnout rate. Software SPSS version 18 was used for data analysis. Results: Females adults were more affected; prevalence of sputum positivity/HIV co-infection were 15.1% (14% in adult; 1.1% in children) / 62.0% (57.4% in adults; 4.6% in children) respectively. The 7-year trend spiked in year 2015 and 2017, with an observed downward pattern in 2018 in all the ages. Cure after treatment was 6.3% (5.7% in adults and 0.6% in children). Conclusion: Efforts will need to be put into TB diagnosis considering the low sensitivity of sputum smear microscopy in instituting treatment. TB is still a leading opportunistic infection in persons infected with HIV.
Journal of Advances in Medicine and Medical Research
Background: Smear microscopy remains the primary tool for the detection of tuberculosis in Ghana. Laboratory diagnosis of active tuberculosis cases by sputum smear microscopy is a critical component of Directly Observed Treatment, Shortcourse (DOTS). Effective control of tuberculosis in Ghana at the rural level therefore hinges on the quality of local laboratory to provide accurate and reliable direct acid fast bacilli microscopy testing for diagnosis, treatment and monitoring.
Journal of medical and biomedical sciences, 2012
There is paucity of data on the prevalence of pulmonary tuberculosis (PTB) among outpatient attendees from individual Institutions and Health Care Facilities performing sputum smear microscopy in Ghana. This retrospective study analyzed sputum smear microscopy results among pulmonary TB suspected patients presenting to the Tamale Teaching Hospital in the Northern Region of Ghana. Sputum smear microscopy for Acid Fast Bacilli (AFB) results of new suspected pulmonary TB (Diagnosis) patients and their demographic data comprising age and sex recorded from January 2004 to December 2010 were retrieved from the TB Laboratory Register (TB04) of the Bacteriology unit and analyzed. Out of a total of 5,720 registered cases, 4,762 (83.3%) were new patients with suspected pulmonary TB (diagnostic cases). This comprised of 2,766 (58.1%) males and 1,996 (41.9%) females giving a female to male ratio of 1:1.4. Assessment of recorded data for newly suspected pulmonary TB patients rose from a minimum of 165 (9.9%) in 2004 to a maximum of 948 (19.9%) in 2009. Out of a total of the 4,762 recorded new cases, 620 were sputum smear positive yielding positivity rate of 13.0%. The positivity rate on a year-on-year basis was 15.7% (2004), 15.8% (2005), 13.4% (2006), 12.7% (2007), 20.6% (2008), 10.0% (2009) and 6.3% (2010). The median age for recorded smear positive cases was 42 years. Generally the percentage proportion of smear positives in the recorded cases stratified by age showed a steady rise from 0.3% in the <5 year olds and peaked at 16.3% in the 30-35 years age group. A gradual decline in smear positive cases was observed within the 36-41 years age group from 10.0% to 4.8% in the 54-59 years age group from where a gradual rise was observed up to the >72 years age group. There has been a remarkable improvement in diagnostic requests for suspected TB patients. The decline in positivity rates might have been impacted upon greatly by the national strategy to stop TB which emphasized on active case finding and prompt reporting at the community level, improving diagnostic processes and strengthening the health systems. The rapid urbanization and changes in the social fibre of inhabitants cannot be underestimated in the overall TB control efforts.