Magomere Robert Shihuzire, Mutai Beatrice
Department of Health, Bungoma County, Bungoma, Kenya.
Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya.
Int J Health Sci Res. 2023 Oct;13(10):177-185. doi: 10.52403/ijhsr.20231024.
Tuberculosis (TB) contact screening though highly recommended is seldom practiced in low- and middle-income countries due to lack of evidence-based approaches best suited to the local setting. We assessed the yield of TB contact screening and predictors of TB diagnosis at a county referral hospital in Western Kenya. We identified clients with TB disease at Bungoma county referral hospital between January and December 2021, who completed a standard questionnaire and identified potential close contacts. We described the characteristics and yield of TB disease among contacts using means, standard deviation, counts and proportions. We used logistic regression to determine factors associated with TB diagnosis for contacts and reported odds ratios and 95% confidence intervals (95% CI). We identified 105 index TB cases who identified 358 contacts. The yield of TB disease among the contacts was 11% (39/353). The mean age of the TB contacts was 29.2 years (SD 19.3) and 87.8% (310/353) were household contacts. Body mass index of 18.5 kg/m and above was associated with 89% lower odds of TB disease among contacts (OR 0.11, 95% CI: 0.05-0.25). Contacts who had ever smoked were 3 times more likely to be diagnosed with TB disease (OR 3.10, 95% CI: 1.56-6.15). Contacts who used wood/kerosene for cooking had 3.5 times higher odds of TB disease (OR 3.5 95% CI: 1.05-11.72). Contact screening has a high yield of TB disease. Targeted approach directed towards contacts with malnutrition, smokers, and those using wood/kerosene for cooking may increase TB yield among contacts.
尽管强烈建议开展结核病(TB)接触者筛查,但由于缺乏最适合当地情况的循证方法,中低收入国家很少实施。我们评估了肯尼亚西部一家县级转诊医院的结核病接触者筛查结果及结核病诊断的预测因素。我们在2021年1月至12月期间,在邦戈马县转诊医院确定了患有结核病的患者,他们填写了一份标准问卷,并确定了潜在的密切接触者。我们用均值、标准差、计数和比例描述了接触者中结核病的特征和筛查结果。我们使用逻辑回归来确定与接触者结核病诊断相关的因素,并报告比值比和95%置信区间(95%CI)。我们确定了105例索引结核病病例,他们确定了358名接触者。接触者中的结核病筛查结果为11%(39/353)。结核病接触者的平均年龄为29.2岁(标准差19.3),87.8%(310/353)为家庭接触者。体重指数在18.5 kg/m及以上的接触者患结核病的几率降低89%(比值比0.11,95%CI:0.05-0.25)。曾经吸烟的接触者被诊断为结核病的可能性高出3倍(比值比3.10,95%CI:1.56-6.15)。使用木材/煤油做饭的接触者患结核病的几率高出3.5倍(比值比3.5,95%CI:1.05-11.72)。接触者筛查有很高的结核病发现率。针对营养不良、吸烟者以及使用木材/煤油做饭的接触者采取有针对性的方法,可能会提高接触者中的结核病发现率。