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. 2021 Jun;76(6):607-614.
doi: 10.1136/thoraxjnl-2020-216123. Epub 2021 Jan 27.

'If not TB, what could it be?' Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Brenda Nyambura Mungai  1 , Elizabeth Joekes  2   3 , Enos Masini  4   5 , Angela Obasi  6   7 , Veronica Manduku  8 , Beatrice Mugi  9 , Jane Ong'angò  8 , Dickson Kirathe  10 , Richard Kiplimo  10 , Joseph Sitienei  10 , Rose Oronje  11 , Ben Morton  2   12   13 , Stephen Bertel Squire  2   6   12   14 , Peter MacPherson  2   12   15 ; IMPALA Consortium
Collaborators, Affiliations

'If not TB, what could it be?' Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Brenda Nyambura Mungai et al. Thorax. 2021 Jun.

Abstract

Background: The prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.

Methods: We reviewed a random sample of 1140 adult (≥15 years) CXRs classified as 'abnormal, suggestive of TB' or 'abnormal other' during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.

Findings: Cardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.

Interpretation: Based on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.

Funding: National Institute for Health Research (IMPALA-grant reference 16/136/35).

Keywords: COPD epidemiology; bronchiectasis; emphysema; imaging/CT MRI etc; tuberculosis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram showing participant flow from the Kenya National TB Prevalence Survey and this nested chest X-ray (CXR) study.
Figure 2
Figure 2
Prevalence of abnormalities by major diagnostic categories. PTB, pulmonary TB.
Figure 3
Figure 3
Euler diagram of abnormalities identified during the chest X-ray study.
See this image and copyright information in PMC

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