Feasey Helena R A, Khundi McEwen, Nzawa Soko Rebecca, Nightingale Emily, Burke Rachael M, Henrion Marc Y R, Phiri Mphatso D, Burchett Helen E, Chiume Lingstone, Nliwasa Marriott, Twabi Hussein H, Mpunga James A, MacPherson Peter, Corbett Elizabeth L
London School of Hygiene and Tropical Medicine, London, United Kingdom.
African Institute for Development Policy, Lilongwe, Malawi.
PLOS Glob Public Health. 2023 Oct 20;3(10):e0001911. doi: 10.1371/journal.pgph.0001911. eCollection 2023.
Recent evidence shows rapidly changing tuberculosis (TB) epidemiology in Southern and Eastern Africa, with need for subdistrict prevalence estimates to guide targeted interventions. We conducted a pulmonary TB prevalence survey to estimate current TB burden in Blantyre city, Malawi. From May 2019 to March 2020, 115 households in middle/high-density residential Blantyre, were randomly-selected from each of 72 clusters. Consenting eligible participants (household residents ≥ 18 years) were interviewed, including for cough (any duration), and offered HIV testing and chest X-ray; participants with cough and/or abnormal X-ray provided two sputum samples for microscopy, Xpert MTB/Rif and mycobacterial culture. TB disease prevalence and risk factors for prevalent TB were calculated using complete-case analysis, multiple imputation, and inverse probability weighting. Of 20,899 eligible adults, 15,897 (76%) were interviewed, 13,490/15,897 (85%) had X-ray, and 1,120/1,394 (80%) sputum-eligible participants produced at least one specimen, giving 15,318 complete cases (5,895, 38% men). 29/15,318 had bacteriologically-confirmed TB (189 per 100,000 complete-case (cc) / 150 per 100,000 with inverse weighting (iw)). Men had higher burden (cc: 305 [95% CI:144-645] per 100,000) than women (cc: 117 [95% CI:65-211] per 100,000): cc adjusted odds ratio (aOR) 2.70 (1.26-5.78). Other significant risk factors for prevalent TB on complete-case analysis were working age (25-49 years) and previous TB treatment, but not HIV status. Multivariable analysis of imputed data was limited by small numbers, but previous TB and age group 25-49 years remained significantly associated with higher TB prevalence. Pulmonary TB prevalence for Blantyre was considerably lower than the 1,014 per 100,000 for urban Malawi in the 2013-14 national survey, at 150-189 per 100,000 adults, but some groups, notably men, remain disproportionately affected. TB case-finding is still needed for TB elimination in Blantyre, and similar urban centres, but should focus on reaching the highest risk groups, such as older men.
近期证据显示，南部和东部非洲的结核病（TB）流行病学正在迅速变化，需要进行分区患病率估计以指导有针对性的干预措施。我们开展了一项肺结核患病率调查，以估计马拉维布兰太尔市目前的结核病负担。2019年5月至2020年3月，从72个聚类中的每一个中随机选择了布兰太尔中/高密度住宅区的115户家庭。同意参与的符合条件的参与者（≥18岁的家庭居民）接受了访谈，包括询问咳嗽情况（任何持续时间），并接受了HIV检测和胸部X光检查；有咳嗽和/或X光异常的参与者提供了两份痰样本用于显微镜检查、Xpert MTB/Rif检测和分枝杆菌培养。使用完全病例分析、多重插补和逆概率加权法计算结核病患病率和现患结核病的危险因素。在20899名符合条件的成年人中，15897人（76%）接受了访谈，13490/15897人（85%）进行了X光检查，1120/1394名符合痰检条件的参与者至少提供了一份样本，得到15318个完全病例（5895人，38%为男性）。29/15318人患有细菌学确诊的结核病（每100000个完全病例中有189例（cc）/每100000个采用逆加权法（iw）的病例中有150例）。男性的负担更高（cc：每100000人中有305例[95%置信区间：144 - 645]），高于女性（cc：每100000人中有117例[95%置信区间：65 - 211]）：cc调整优势比（aOR）为2.70（1.26 - 5.78）。在完全病例分析中，现患结核病的其他显著危险因素是工作年龄（25 - 49岁）和既往结核病治疗史，但不包括HIV状态。对插补数据的多变量分析因样本量小而受到限制，但既往结核病和25 - 49岁年龄组仍与较高的结核病患病率显著相关。布兰太尔的肺结核患病率远低于2013 - 14年全国调查中马拉维城市每100000人1014例的水平，为每100000名成年人中有150 - 189例，但一些群体，尤其是男性，仍然受到不成比例的影响。在布兰太尔以及类似的城市中心，为实现结核病消除仍需要开展病例发现工作，但应侧重于针对最高风险群体，如老年男性。
