Mohammed Hussen, Oljira Lemessa, Teji Roba Kedir, Ngadaya Esther, Mehari Roman, Manyazewal Tsegahun, Yimer Getnet
Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Risk Manag Healthc Policy. 2021 Nov 25;14:4749-4756. doi: 10.2147/RMHP.S337392. eCollection 2021.
Recent country surveys have shown an unacceptably high prevalence of confirmed tuberculosis (TB) even among those with a low duration of cough, and more than 50% of those with bacteriologically confirmed pulmonary tuberculosis (PTB) do not report symptoms that correspond to presumptive TB. Furthermore, there has been an increase in the incidence of smear-negative PTB patients who can serve as a source of infection. We investigated whether screening people who sought healthcare for cough of any duration can increase TB case detection in Ethiopia, and compiled the lessons learned and recommendations.
We carried out a facility-based study in Ethiopia. All consenting participants who sought any healthcare at the outpatients department, and healthcare facilities for reproductive and child health, anti-retroviral therapy, and diabetes were screened for cough of any duration, and those with cough underwent further investigations using chest radiography (CXR) (except for pregnant women, patients on anti-retroviral therapy, and diabetic patients) and microbiological tests. Confirmed cases were linked to TB treatment following the country's standard guidelines.
We screened 195,713 people who sought healthcare for cough of any duration. Of these, 2647 reported cough symptom of any duration, of whom 1853 underwent further diagnostic tests as they fulfilled the criteria for presumptive TB. Overall, 309/1853 (16.7%) were diagnosed with PTB and linked to TB treatment. Screening by cough of any duration and/or CXR improved TB case finding, and engaging all health teams (administrative and supportive staff, as well as healthcare providers) in the TB screening and diagnosis significantly improved the process.
Screening for TB using cough of any duration and/or CXR for any patient who sought healthcare has the potential to increase both the number of presumptive TB cases and the number of patients diagnosed with and treated for TB in Ethiopia. Such initiatives require strong engagement of facility staff, regular maintenance and calibration of TB diagnostic equipment, and uninterrupted reagent supplies.
近期的全国调查显示，即使在咳嗽时间较短的人群中，确诊肺结核（TB）的患病率也高得令人难以接受，并且超过50%的痰菌确诊肺结核（PTB）患者未报告符合疑似结核病的症状。此外，涂片阴性PTB患者作为传染源的发病率有所增加。我们调查了对因咳嗽前来就医的患者（无论咳嗽持续时间长短）进行筛查是否能增加埃塞俄比亚的结核病病例发现，并总结了经验教训和建议。
我们在埃塞俄比亚开展了一项基于机构的研究。所有在门诊部寻求任何医疗服务的同意参与者，以及生殖和儿童健康、抗逆转录病毒治疗及糖尿病的医疗机构，均接受了任何持续时间咳嗽的筛查，咳嗽患者（孕妇、接受抗逆转录病毒治疗的患者及糖尿病患者除外）进一步接受胸部X线摄影（CXR）及微生物学检测。确诊病例按照该国标准指南接受结核病治疗。
我们对195,713名因任何持续时间咳嗽前来就医的患者进行了筛查。其中，2647人报告有任何持续时间的咳嗽症状，其中1853人因符合疑似结核病标准而接受了进一步诊断检测。总体而言，1853人中309人（16.7%）被诊断为PTB并接受结核病治疗。通过对任何持续时间咳嗽和/或CXR进行筛查可改善结核病病例发现情况，让所有卫生团队（行政和支持人员以及医疗服务提供者）参与结核病筛查和诊断可显著改善这一过程。
对任何前来就医的患者使用任何持续时间咳嗽和/或CXR进行结核病筛查，有可能增加埃塞俄比亚疑似结核病病例数量以及确诊并接受结核病治疗的患者数量。此类举措需要机构工作人员的大力参与、结核病诊断设备的定期维护和校准以及不间断的试剂供应。
