Department of Pathology, Faculty of Medicine and Health Sciences (FMHS), Midlands State University, Gweru, Zimbabwe.
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, National TB Control Programme, Ministry of Health and Child Care, Harare, Zimbabwe.
Int J Tuberc Lung Dis. 2022 Jan 1;26(1):57-64. doi: 10.5588/ijtld.21.0341.
We conducted the first national TB prevalence survey to provide accurate estimates of bacteriologically confirmed pulmonary TB disease among adults aged ≥15 years in 2014. A TB symptoms screen and chest X-ray (CXR) were used to identify presumptive TB cases who submitted two sputum samples for smear microscopy, liquid and solid culture. Bacteriological confirmation included acid-fast bacilli smear positivity confirmed using Xpert MTB/RIF and/or culture. Prevalence estimates were calculated using random effects logistic regression with multiple imputations and inverse probability weighting. Of 43,478 eligible participants, 33,736 (78%) were screened; of these 5,820 (17%) presumptive cases were identified. There were 107 (1.9%) bacteriologically confirmed TB cases, of which 23 (21%) were smear-positive. The adjusted prevalences of smear-positive and bacteriologically confirmed TB disease were respectively 82/100,000 population (95% CI 47-118/100,000) and 344/100,000 (95% CI 268-420/100,000), with an overall all-ages, all-forms TB prevalence of 275/100,000 population (95% CI 217-334/100,000). TB prevalence was higher in males, and age groups 35-44 and ≥65 years. CXR identified 93/107 (87%) cases vs. 39/107 (36%) using the symptom screen. Zimbabwe TB disease prevalence has decreased relative to prior estimates, possibly due to increased antiretroviral therapy coverage and successful national TB control strategies. Continued investments in TB diagnostics for improved case detection are required.
我们开展了首次全国结核病患病率调查，以提供 2014 年 15 岁及以上成年人中经细菌学确诊的肺结核病的准确估计数。采用结核病症状筛查和胸部 X 光检查（CXR）来确定疑似结核病病例，这些疑似病例需提交两份痰样本进行涂片显微镜检查、液体和固体培养。细菌学确证包括使用 Xpert MTB/RIF 和/或培养对酸性杆菌涂片阳性进行确认。患病率估计值采用随机效应逻辑回归进行计算，同时进行多项插补和逆概率加权。在 43478 名符合条件的参与者中，有 33736 名（78%）接受了筛查；其中 5820 名（17%）为疑似病例。有 107 名（1.9%）经细菌学确证的结核病病例，其中 23 名（21%）为涂片阳性。调整后的涂片阳性和经细菌学确证的结核病患病率分别为 82/100000 人口（95%CI 47-118/100000）和 344/100000 人口（95%CI 268-420/100000），全年龄段、全类型结核病总患病率为 275/100000 人口（95%CI 217-334/100000）。男性、35-44 岁和≥65 岁年龄组的结核病患病率较高。CXR 比症状筛查发现了 93/107（87%）例病例，而症状筛查发现了 39/107（36%）例病例。与之前的估计相比，津巴布韦的结核病患病率有所下降，这可能是由于抗逆转录病毒治疗覆盖率的提高和成功实施国家结核病控制策略所致。需要继续投资结核病诊断，以提高病例检出率。
