Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan 17;19(1):60.
doi: 10.1186/s12879-019-3716-x.

Missed pulmonary tuberculosis: a cross sectional study in the general medical inpatient wards of a large referral hospital in Ethiopia

Dawit Assefa  1 , Feleke Belachew  2 , Getachew Wondimagegn  3 , Eveline Klinkenberg  4   5
Affiliations

Missed pulmonary tuberculosis: a cross sectional study in the general medical inpatient wards of a large referral hospital in Ethiopia

Dawit Assefa et al. BMC Infect Dis. .

Abstract

Background: Every year around 4 million people with tuberculosis (TB) are not detected. Thus may not get the medical care that they need and deserve from their respective health systems. Ethiopia is included in the 12 countries who contribute 75% of the globally estimated "missed" cases. This study assessed if there are missed Pulmonary TB (PTB) cases among inpatients of a large referral hospital in Ethiopia.

Method: A cross sectional survey was conducted in the general medical wards of the large referral hospital from June to August 2015. Inpatients not diagnosed with TB were screened for TB symptoms and requested to submit a morning sputum sample for smear microscopy and molecular testing by GeneXpert MTB/RIF assay. The results of the symptom screening, smear and GeneXpert testing were analyzed as the main outcome characteristics for "missed" PTB cases.

Result: Over the 3-month period, 300 inpatients were evaluated for TB. The patients median age was 38 years (IQR 26-51.5), 41% were female, median reported duration of sickness before admission was 30 days (IQR 14-240), and median body mass index (BMI) was 21.5 (IQR 20-22.67). HIV status was documented for 198/300 (66%) of patients, 37 (18.7%) were found to be HIV positive, with a median CD4 count of 176 (IQR 52-400). All 300 inpatients submitted a sputum sample and 10 (3.3%) were found to be GeneXpert MTB positive, with 4/10 also being smear positive. All GeneXpert positive inpatients reported having a cough of > 2 weeks duration. Eight had at least 3 common symptoms of TB (i.e. cough, fever, weight loss or night sweat). Co-morbidity with Diabetes Mellitus (DM) and HIV was found in 1/10 and 4/10 cases respectively.

Conclusion: Bacteriological confirmed TB cases were found to have been "missed" amongst the general medical ward inpatients in the hospital. The identified TB cases all reported typical signs and symptoms of TB. Basic clinical practices were not being followed (i.e. history taking/documentation and requesting of appropriate laboratory tests) by the attending health care workers (HCWs) in the hospital. The index of suspicion for TB disease needs to improve and the use of more sensitive technologies, such as GeneXpert could assist the diagnosis of TB. However, the findings of the study need to be investigated in other hospital settings in Ethiopia.

Keywords: Clinical practice; GeneXpert testing; Pulmonary Tuberculosis; TB screening.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The ethics committee of Oromiya regional health bureau provided clearance for the protocol including the information sheet and consent form. Written informed consent was obtained from all participants by the interviewers after verbal explanation of the overall purpose, risk and benefit of participation in the study. Participants were reassured that participation in the study was voluntary and non-participation would not affect the care or service obtained from the health facility.

Consent for publication

Not applicable.

Competing interests

The Authors declare that they have no competing interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram – TB screening and sputum result of patients in the medical wards
See this image and copyright information in PMC

References

    1. World Health Organization 2014. Tb. Reach the 3 million. Find. Treat. Cure TB. Accessed, http://www.stoptb.org/assets/documents/resources/publications/acsm/WORLD....
    1. World Health Organization 2015. Global Tuberculosis report 2015. WHO/HTM/TB/201522.
    1. Field N, Murray J, Wong ML, et al. Missed opportunities in TB diagnosis: a TB process-based performance review tool to evaluate and improve clinical care. BMC Public Health. 2011;11:127. doi: 10.1186/1471-2458-11-127. - DOI - PMC - PubMed
    1. Sendagire I, Schim Van der Loeff M, Mubiru M, Konde-Lule J, Cobelens F. Long Delays and Missed Opportunities in Diagnosing Smear-Positive Pulmonary Tuberculosis in Kampala, Uganda: A Cross-Sectional Study. PLoS One. 2010;5(12):e14459. doi: 10.1371/journal.pone.0014459. - DOI - PMC - PubMed
    1. Greenaway C, Menzies D, Fanning A, et al. Delay in Diagnosis among Hospitalized Patients with Active Tuberculosis – Predictors and Outcomes. Am J Respir Crit Care Med Vol, 165. 2002:927–33. 10.1164/rccm.2107040. - PubMed