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. 2019 May 10;19(1):91.
doi: 10.1186/s12890-019-0853-3.

A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda

Nicholas Sebuliba Kirirabwa  1 , Derrick Kimuli  2 , Carol Nanziri  2 , Denis Sama  2 , Syrus Ntudhu  3 , Daniel Ayen Okello  4 , Raymond Byaruhanga  2 , Deus Lukoye  2 , Samuel Kasozi  2
Affiliations

A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda

Nicholas Sebuliba Kirirabwa et al. BMC Pulm Med. .

Abstract

Background: The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread.

Method: A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done.

Results: Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013).

Conclusion: The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.

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Conflict of interest statement

Ethics approval and consent to participate

The assessment was conducted under the guidance and approval of the Kampala Capital City Authority. Since the study was based on records review, re-verification and re-analysis of routinely collected information and reports by Kampala Capital City Authorities [26, 27], ethical approval was not necessary. In addition, since no patient identifying information was used, the investigators did not consider patient consent as a requirement for this study. There was no anticipated risk or benefit to the patients in the analysis of this information.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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

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