Banti Abiot Bezabeh, Datiko Daniel Gemechu, Winje Brita Askeland, Hinderaker Sven Gudmund, Heldal Einar, Dangisso Mesay Hailu
Global Public Health and Primary Care, University of Bergen, Bergen, Norway
REACH Ethiopia, Addis Ababa, Ethiopia.
BMJ Open. 2025 Apr 19;15(4):e093155. doi: 10.1136/bmjopen-2024-093155.
A 'cluster' is an area with a higher occurrence of tuberculosis (TB) than would be expected in an average random distribution of that area. Tuberculosis clustering is commonly reported in Ethiopia, but most studies rely on registered data, which may miss patients who do not visit health facilities or those who attend but are not identified as having TB. This makes the detection of actual clusters challenging. This study analysed the clustering of pulmonary TB and associated risk factors using symptom-based population screening in Dale, Ethiopia.
A prospective population-based cohort study.
All households in 383 enumeration areas were visited three times over a 1-year period, at 4-month intervals.
Individuals with pulmonary TB aged ≥15 years with demographic, socioeconomic, clinical and geographical data residing in 383 enumeration areas (ie, the lowest unit/village in the kebele, each with approximately 600 residents).
Pulmonary TB (ie, bacteriologically confirmed by sputum microscopy, GeneXpert or culture plus clinically diagnosed pulmonary TB) and pulmonary TB clustering.
We identified pulmonary TB clustering in 45 out of the 383 enumeration areas. During the first round of screening, 39 enumeration areas showed pulmonary TB clustering, compared with only 3 enumeration areas in the second and third rounds. Our multilevel analysis found that enumeration areas with clusters were located farther from the health centres than other enumeration areas. No other determinants examined were associated with clustering.
The distribution of pulmonary TB was clustered in enumeration areas distant from the health centres. Routine systematic community screening may be costly, but using existing health infrastructure with health extension workers through targeted screening, they can identify and refer persons with TB symptoms more quickly for diagnosis and treatment, thereby decreasing the duration of disease transmission and contributing to the reduction of TB burden.
“聚集区”是指结核病（TB）发病率高于该地区平均随机分布预期的区域。埃塞俄比亚经常报告结核病聚集情况，但大多数研究依赖登记数据，这可能会遗漏未前往医疗机构就诊的患者或虽就诊但未被确诊为结核病的患者。这使得检测实际聚集区具有挑战性。本研究在埃塞俄比亚的戴尔通过基于症状的人群筛查分析了肺结核的聚集情况及相关危险因素。
一项基于人群的前瞻性队列研究。
在1年时间内，以4个月为间隔，对383个普查区的所有家庭进行了3次走访。
年龄≥15岁、居住在383个普查区（即凯贝勒的最低单位/村庄，每个村庄约有600名居民）且具有人口统计学、社会经济、临床和地理数据的肺结核患者。
肺结核（即通过痰涂片显微镜检查、GeneXpert检测或培养以及临床诊断确诊的肺结核）和肺结核聚集情况。
我们在383个普查区中的45个区发现了肺结核聚集现象。在第一轮筛查中，有39个普查区显示出肺结核聚集，而在第二轮和第三轮筛查中，仅有3个普查区出现聚集。我们的多水平分析发现，有聚集区的普查区距离医疗中心比其他普查区更远。所检查的其他决定因素均与聚集无关。
肺结核的分布在远离医疗中心的普查区呈聚集状态。常规的系统社区筛查可能成本较高，但通过现有卫生基础设施，利用卫生推广工作者进行有针对性的筛查，能够更快地识别并转诊有结核病症状的人员以便进行诊断和治疗，从而缩短疾病传播时间，有助于减轻结核病负担。
