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Meta-Analysis
. 2016 Jun 13:16:282.
doi: 10.1186/s12879-016-1617-9.

Smear positivity in paediatric and adult tuberculosis: systematic review and meta-analysis

Amber Kunkel  1   2 , Pia Abel Zur Wiesch  1   3   4 , Ruvandhi R Nathavitharana  5 , Florian M Marx  1   6 , Helen E Jenkins  6 , Ted Cohen  7
Affiliations
Meta-Analysis

Smear positivity in paediatric and adult tuberculosis: systematic review and meta-analysis

Amber Kunkel et al. BMC Infect Dis. .

Abstract

Background: Tuberculosis (TB) diagnosis continues to rely on sputum smear microscopy in many settings. We conducted a meta-analysis to estimate the percentage of children and adults with tuberculosis that are sputum smear positive.

Methods: We searched PubMed, MEDLINE, Embase, and Global Health databases for studies that included both children and adults with all forms of active TB. The pooled percentages of children and adults with smear positive TB were estimated using the inverse variance heterogeneity model. This review was registered in the PROSPERO database under registration number CRD42015015331.

Results: We identified 20 studies meeting our inclusion criteria that reported smear positivity for a total of 18,316 children and 162,574 adults from 14 countries. The pooled percentage of paediatric TB cases that were sputum smear positive was 6.8 % (95 % Confidence Interval (CI) 2.2-12.2 %), compared with 52.0 % (95 % CI 40.0-64.0 %) among adult cases. Eight studies reported data separately for children aged 0-4 and 5-14. The percentage of children aged 0-4 that were smear positive was 0.5 % (95 % CI 0.0-1.9 %), compared with 14.0 % (95 % CI 8.9-19.4 %) among children aged 5-14.

Conclusions: Children, especially those aged 0-4, are much less likely to be sputum smear positive than adults. National TB programs relying on sputum smear for diagnosis are at risk of under-diagnosing and underestimating the burden of TB in children.

Keywords: Acid-fast bacilli; Age-specific; Child; Diagnosis; Sputum microscopy.

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Figures

Fig. 1
Fig. 1
Deatils of literature search leading to the selection of included studies
Fig. 2
Fig. 2
Forest plot of smear positivity percentage among children
Fig. 3
Fig. 3
Forest plot of smear positivity percentage among adults
Fig. 4
Fig. 4
Forest plots of smear positivity percentage among (a) younger children (ages 0-4 years) and (b) older children (ages 5-14 years)
See this image and copyright information in PMC

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