Arega Balew, Tilahun Kelemu, Minda Abraham, Agunie Asnake, Mengistu Getachew
Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
College of Health Science, Wolega University, Wolega, Ethiopia.
Arch Public Health. 2019 Jul 11;77:33. doi: 10.1186/s13690-019-0360-2. eCollection 2019.
In Ethiopia individual report indicated nearly 30% of incident cases of tuberculosis remained undiagnosed. Therefore, this systematic review and meta-analysis was aimed to determine the pooled prevalence rate of undiagnosed smear positive pulmonary tuberculosis (PTB) using community based studies published in Ethiopia.
MEDLINE/PubMed, 'Cochrane' library, and Google scholar databases were searched, and reference list of studies on tuberculosis in Ethiopia were reviewed. We used table to present descriptive information of original studies and quantitative results were presented in forest plots. The Cochrane Q test and I test statistic were used to test heterogeneity across studies. The Pooled prevalence and point estimates of undiagnosed smear positive PTB were computed by a random effects model.
From the nine studies included in the analysis, the pooled prevalence rate and point estimate of undiagnosed smear positive PTB was 0.11%(95% CI, 0.06-013%, < 0.001) and 79.8/100,000(95% CI; 56.3-112.8) respectively. Pooled prevalence rate and point estimate of bacteriologically confirmed PTB were 0.17%(95%CI; 0.13-0.22%, < 0.001) and 191/100000(95% CI; 141.3-258) respectively. The ratio of active to passive case detection was 2.3(95% CI, 0.42-4.1). Pooled prevalence rate of presumptive PTB was 2.7%(95% CI; 1.3-5.3%).
The analysis revealed that the magnitude of undiagnosed smear positive PTB cases in the community is high in Ethiopia. This indicated the ongoing transmission of tuberculosis in community due to missed infectious cases. Active tuberculosis finding in the community should be strengthened in Ethiopia.
在埃塞俄比亚，个别报告指出近30%的结核病新发病例仍未得到诊断。因此，本系统评价和荟萃分析旨在利用埃塞俄比亚发表的基于社区的研究，确定未诊断出的涂片阳性肺结核（PTB）的合并患病率。
检索了MEDLINE/PubMed、“Cochrane”图书馆和谷歌学术数据库，并查阅了埃塞俄比亚结核病研究的参考文献列表。我们用表格展示原始研究的描述性信息，定量结果用森林图呈现。采用Cochrane Q检验和I检验统计量来检验各研究间的异质性。未诊断出的涂片阳性PTB的合并患病率和点估计值通过随机效应模型计算。
在纳入分析的9项研究中，未诊断出的涂片阳性PTB的合并患病率和点估计值分别为0.11%（95%CI，0.06 - 0.13%）和79.8/100,000（95%CI；56.3 - 112.8）。细菌学确诊的PTB的合并患病率和点估计值分别为0.17%（95%CI；0.13 - 0.22%）和191/100,000（95%CI；141.3 - 258）。主动病例发现与被动病例发现的比例为2.3（95%CI，0.42 - 4.1）。推定PTB的合并患病率为2.7%（95%CI；1.3 - 5.3%）。
分析显示，埃塞俄比亚社区中未诊断出的涂片阳性PTB病例数量众多。这表明由于感染病例的漏诊，结核病在社区中持续传播。埃塞俄比亚应加强社区内的活动性结核病筛查。
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