Department of Global Health, University of Washington, Seattle, WA, Institute for Health Metrics and Evaluation, Seattle, WA, USA.
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
Int J Tuberc Lung Dis. 2022 Apr 1;26(4):356-362. doi: 10.5588/ijtld.21.0624.
TB was the leading cause of death from a single infectious pathogen globally between 2014 and 2019. Fine-scale estimates of TB prevalence and case notifications can be combined to guide priority-setting for strengthening routine surveillance activities in high-burden countries. We produce policy-relevant estimates of the TB epidemic at the second administrative unit in Bangladesh. We used a Bayesian spatial framework and the cross-sectional National TB Prevalence Survey from 2015-2016 in Bangladesh to estimate prevalence by district. We used case notifications to calculate prevalence-to-notification ratio, a key metric of under-diagnosis and under-reporting. TB prevalence rates were highest in the north-eastern districts and ranged from 160 cases per 100,000 (95% uncertainty interval [UI] 80-310) in Jashore to 840 (UI 690-1020) in Sunamganj. Despite moderate prevalence rates, the Rajshahi and Dhaka Divisions presented the highest prevalence-to-notification ratios due to low case notifications. Resolving subnational disparities in case detection could lead to 26,500 additional TB cases (UI 8,500-79,400) notified every year. This study is the first to produce and map subnational estimates of TB prevalence and prevalence-to-notification ratios, which are essential to target prevention and treatment efforts in high-burden settings. Reaching TB cases currently missing from care will be key to ending the TB epidemic.
2014 年至 2019 年，结核病是全球单一传染病病原体导致死亡的主要原因。精细的结核病流行率和病例报告估计数可以结合起来，指导高负担国家加强常规监测活动的重点制定。我们在孟加拉国的第二个行政单位生成了与政策相关的结核病流行估计数。我们使用贝叶斯空间框架和 2015-2016 年孟加拉国的全国结核病流行率横断面调查，按区估计流行率。我们使用病例报告来计算患病率与报告率之比，这是诊断不足和报告不足的一个关键指标。结核病患病率在东北部地区最高，从贾肖尔的每 10 万人 160 例（95%置信区间 [UI] 80-310）到孙纳姆甘杰的 840 例（UI 690-1020）不等。尽管流行率适中，但由于病例报告率较低，拉杰沙希和达卡行政区的患病率与报告率之比最高。解决病例发现方面的次国家差异可能会导致每年额外报告 26500 例结核病病例（UI 8500-79400）。这项研究首次生成并绘制了结核病流行率和患病率与报告率的次国家估计数，这对于在高负担环境中确定预防和治疗重点至关重要。找到目前治疗中遗漏的结核病患者将是终结结核病流行的关键。
