Centre for International Health, University of Bergen, Bergen, Norway
REACH Ethiopia, Addis Ababa, Ethiopia.
BMJ Open. 2023 Jul 30;13(7):e070594. doi: 10.1136/bmjopen-2022-070594.
In Ethiopia, one-third of the estimated tuberculosis cases are not detected or reported. Incidence estimates are inaccurate and rarely measured directly. Assessing the 'real' incidence under programme conditions is useful to understand the situation. This study aimed to measure the prevalence and incidence of symptomatic pulmonary tuberculosis (PTB) during 1 year in the adult population of Dale in Ethiopia.
A prospective population-based cohort study.
Every household in Dale was visited three times at 4-month intervals.
Individuals aged ≥15 years.
Microscopy smear positive PTB (PTB s+), bacteriologically confirmed PTB (PTB b+) by microscopy, GeneXpert, or culture and clinically diagnosed PTB (PTB c+).
Among 136 181 individuals, 2052 had presumptive TB (persistent cough for 14 days or more with or without ), in the first round of household visits including 93 with PTB s+, 98 with PTB b+ and 24 with PTB c+; adding those with PTB who were already on treatment, the total number of PTB was 201, and the prevalence was 147 (95% CI: 127 to 168)/100 000 population. Out of all patients with PTB, the proportion detected by symptom screening was in PTB s+ 65%, PTB b+ 67% and PTB c+44%. During 96 388 person-years follow-up, 1909 had presumptive TB, 320 had PTB and the total incidence of PTB was 332 (95% CI: 297 to 370)/100 000 person-years, while the incidence of PTB s+, PTB b+ and PTB c+ was 230 (95% CI: 201 to 262), 263 (95% CI: 232 to 297) and 68 (95% CI: 53 to 86)/100 000 person-years, respectively.
The prevalence of symptomatic sputum smear-positive TB was still high, only one-third of prevalent PTB cases notified and the incidence rate highest in the age group 25-34 years, indicating ongoing transmission. Finding missing people with TB through repeated symptom screening can contribute to reducing transmission.
在埃塞俄比亚，约有三分之一的结核病估计病例未被发现或报告。发病率估计不准确，且很少直接测量。在规划条件下评估“真实”发病率有助于了解情况。本研究旨在衡量达勒成年人人群中，1 年内有症状的肺结核（PTB）的患病率和发病率。
前瞻性基于人群的队列研究。
达勒的每个家庭每 4 个月家访 3 次。
年龄≥15 岁的个人。
显微镜下涂片阳性的肺结核（PTB s+）、显微镜、GeneXpert 或培养物检测到的细菌学确诊的肺结核（PTB b+）和临床诊断的肺结核（PTB c+）。
在 136181 名个体中，第 1 轮家访中共有 2052 人有疑似结核病（持续咳嗽 14 天或以上，无论是否有 ），其中包括 93 例 PTB s+、98 例 PTB b+和 24 例 PTB c+；加上已经接受治疗的 PTB 患者，PTB 总数为 201 例，患病率为 147（95%CI：127 至 168）/100000 人。所有 PTB 患者中，通过症状筛查发现的比例为 PTB s+65%、PTB b+67%和 PTB c+44%。在 96388 人年的随访中，共有 1909 人有疑似结核病，320 人患有 PTB，PTB 的总发病率为 332（95%CI：297 至 370）/100000 人年，而 PTB s+、PTB b+和 PTB c+的发病率分别为 230（95%CI：201 至 262）、263（95%CI：232 至 297）和 68（95%CI：53 至 86）/100000 人年。
有症状的痰涂片阳性肺结核的患病率仍然很高，仅三分之一的现患 PTB 病例得到报告，发病率最高的年龄组为 25-34 岁，表明仍在发生传播。通过反复进行症状筛查找到漏诊的结核病患者有助于减少传播。
