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. 2016 Feb 10;11(2):e0148293.
doi: 10.1371/journal.pone.0148293. eCollection 2016.

Population Based National Tuberculosis Prevalence Survey among Adults (>15 Years) in Pakistan, 2010-2011

Ejaz Qadeer  1 , Razia Fatima  1 , Aashifa Yaqoob  1 , Sabira Tahseen  1 , Mahboob Ul Haq  1 , Abdul Ghafoor  1 , Muhammad Asif  1 , Masja Straetemans  2 , Edine W Tiemersma  2
Affiliations

Population Based National Tuberculosis Prevalence Survey among Adults (>15 Years) in Pakistan, 2010-2011

Ejaz Qadeer et al. PLoS One. .

Abstract

Background: We aimed to determine the prevalence of pulmonary tuberculosis (TB) amongst the adult population in 2010-2011 in Pakistan.

Method: A nationwide cross-sectional survey with multistage cluster sampling was conducted among adults (≥15 years) in 95 clusters in 2010-2011. All consenting participants were screened for cough and by chest X-ray. Participants with presumptive TB submitted two sputum samples for smear microscopy, culture, and molecular testing if needed. The TB prevalence estimates were adjusted for missing data and the cluster design.

Result: Of 131,329 eligible individuals, 105,913 (81%) participated in the survey, of whom 10,471 (9.9%) were eligible for sputum examination. We found 341 bacteriologically positive TB cases of whom 233 had sputum smear-positive TB. The adjusted prevalence estimates for smear and bacteriologically positive TB were 270/100,000 (95% confidence interval (CI) 217-323), and 398/100,000 (95% CI 333-463), respectively. Only 61% of the diagnosed TB cases screened positive on symptoms (cough >2wks), whereas the other TB cases were detected based on X-ray abnormalities. The TB prevalence increased with age and was 1.8 times higher among men than women. The prevalence-to-notification ratio of smear-positive TB was 3.1 (95% CI 2.5-3.7), was higher among men than women, and increased with age.

Conclusion: Our data suggest that there is under-detection and/or -notification of TB, especially among men and elderly. TB control should be strengthened specifically in these risk groups. X-ray examination should be combined with symptom screening to enhance case detection.

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Conflict of interest statement

Competing Interests: The authors have the following interests. Masja Straetemans is employed by KIT Biomedical Research. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Flow Diagram of National Prevalence Survey of Pakistan, 2010–11.
See this image and copyright information in PMC

References

    1. WHO (2015). Global Tuberculosis Report 2015.
    1. WHO (2011). Tuberculosis prevalence surveys: a handbook.
    1. WHO (2011). Global Tuberculosis Control.
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    1. National TB Control Program (1990). Pakistan Tuberculosis Prevelance Survey: 1987–1989.

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