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Risk factors for inadequate TB case finding in Rural Western Kenya: a comparison of actively and passively identified TB patients.

ABSTRACT: The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate.We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing characteristics of 194 PTB patients diagnosed in a health facility after self-report, i.e., through passive case detection, with 88 patients identified through active case detection during the prevalence survey. We examined associations between method of case detection and patient characteristics, including HIV-status, socio-demographic variables and disease severity in univariable and multivariable logistic regression analyses.HIV-infection was associated with faster passive case detection in univariable analysis (crude OR 3.5, 95% confidence interval (CI) 2.0-5.9), but in multivariable logistic regression this was largely explained by the presence of cough, illness and clinically diagnosed smear-negative TB (adjusted OR (aOR) HIV 1.8, 95% CI 0.85-3.7). Among the HIV-uninfected passive case detection was less successful in older patients aOR 0.76, 95%CI 0.60-0.97 per 10 years increase), and women (aOR 0.27, 95%CI 0.10-0.73). Reported current or past alcohol use reduced passive case detection in both groups (0.42, 95% CI 0.23-0.79). Among smear-positive patients median durations of cough were 4.0 and 6.9 months in HIV-infected and uninfected patients, respectively.HIV-uninfected patients with infectious TB who were older, female, relatively less ill, or had a cough of a shorter duration were less likely found through passive case detection. In addition to intensified case finding in HIV-infected persons, increasing the suspicion of TB among HIV-uninfected women and the elderly are needed to improve TB case detection in Kenya.

SUBMITTER: Van't Hoog AH

PROVIDER: S-EPMC3636249 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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Risk factors for inadequate TB case finding in Rural Western Kenya: a comparison of actively and passively identified TB patients.

Van't Hoog Anna H AH Marston Barbara J BJ Ayisi John G JG Agaya Janet A JA Muhenje Odylia O Odeny Lazarus O LO Hongo John J Laserson Kayla F KF Borgdorff Martien W MW

PloS one 20130425 4

<h4>Background</h4>The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate.<h4>Objective and methods</h4>We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing cha ...[more]

PMID: 23634206

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Risk factors for inadequate TB case finding in Rural Western Kenya: a comparison of actively and passively identified TB patients.

Publications

Risk factors for inadequate TB case finding in Rural Western Kenya: a comparison of actively and passively identified TB patients.

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