Feasey, Helena RA ORCID: 0000-0003-3109-6722, Khundi, McEwen ORCID: 0000-0003-2718-7576, Nzawa Soko, Rebecca ORCID: 0000-0001-6804-186X, Nightingale, Emily ORCID: 0000-0002-9265-1841, Burke, Rachael M ORCID: 0000-0002-2156-5030, Henrion, Marc YR ORCID: 0000-0003-1242-839X, Phiri, Mphatso D ORCID: 0000-0002-4072-9715, Burchett, Helen E ORCID: 0000-0002-8380-2476, Chiume, Lingstone ORCID: 0000-0002-3893-7814, Nliwasa, Marriott ORCID: 0000-0002-3100-5512 et al (show 4 more authors)
(2023)
Prevalence of bacteriologically-confirmed pulmonary tuberculosis in urban Blantyre, Malawi 2019-20: Substantial decline compared to 2013-14 national survey.
PLOS global public health, 3 (10).
e0001911-.
Abstract
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.
Item Type: | Article |
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Uncontrolled Keywords: | Infectious Diseases, Prevention, Lung, Clinical Research, HIV/AIDS, Tuberculosis, Rare Diseases, 6 Evaluation of treatments and therapeutic interventions, 2 Aetiology, 6.1 Pharmaceuticals, 2.4 Surveillance and distribution, Infection, 3 Good Health and Well Being |
Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
Depositing User: | Symplectic Admin |
Date Deposited: | 21 Dec 2023 16:51 |
Last Modified: | 15 Mar 2024 20:24 |
DOI: | 10.1371/journal.pgph.0001911 |
Open Access URL: | https://doi.org/10.1371/journal.pgph.0001911 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3177605 |