Accuracy and Incremental Yield of the Chest X-Ray in Screening for Tuberculosis in Uganda: A Cross-Sectional Study
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Tuberculosis research and treatment
Abstract
TheWHOEND TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more
sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal
since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was
evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis
of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey
between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using
the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the
CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93%
sensitivity and 65% specificity compared to LJ culture results, while symptoms had 76% sensitivity and 31% specificity. The
screening algorithm involving the CXR in addition to symptoms led to a 38% increment in the yield of diagnosed tuberculosis.
The number needed to screen using the CXR and symptoms screening algorithm was 32 compared to 45 when the symptoms
are used alone. Therefore, the CXR in combination with symptoms is a good TB screening tool and increases the yield of
diagnosed TB.
Description
Keywords
Accuracy, Incremental Yield, Chest X-Ray, Tuberculosis
Citation
Nalunjogi, J., Mugabe, F., Najjingo, I., Lusiba, P., Olweny, F., Mubiru, J., ... & Kirenga, B. (2021). Accuracy and incremental yield of the chest X-ray in screening for tuberculosis in Uganda: a cross-sectional study. Tuberculosis research and treatment, 2021. https://doi.org/10.1155/2021/6622809