Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis.
Authors
Dimambro-Denson, Francesca
Beecroft, Claire
Balen, Julie
Awokola, Babatunde
Mitchell, Caroline
Campbell, Fiona
Dodd, Pete
Publication Date
2023-01Journal Title
Thorax
ISSN
0040-6376
Publisher
BMJ
Language
en
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Jayasooriya, S., Dimambro-Denson, F., Beecroft, C., Balen, J., Awokola, B., Mitchell, C., Kampmann, B., et al. (2023). Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis.. Thorax https://doi.org/10.1136/thoraxjnl-2021-217663
Abstract
BACKGROUND: Many patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed. METHODS: We searched four databases from inception to 27 April 2020, without language restrictions. We included all adult pulmonary tuberculosis diagnostic studies from sub-Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random effects meta-analysis to obtain pooled estimates stratified by passive and active case finding. RESULTS: Our search identified 1799 studies, of which 18 studies (2002-2019) with 14 527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 39.0 to 58.0) in passive and 92.8% (95% CI 85.0 to 96.7) in active case-finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. A history of tuberculosis was documented in 55% of studies, with just five out of 18 reporting any alternative diagnoses. DISCUSSION: Nearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case-finding strategies are used. Little is known about the healthcare needs of these patients. Research is required to better characterise these patient populations and plan health system solutions that meet their needs. PROSPERO REGISTRATION NUMBER: CRD42018100004.
Keywords
Respiratory epidemiology, 1506, 2313, tuberculosis, respiratory infection, clinical epidemiology
Sponsorship
NIHR Global Health Research Unit on Lung Health, IMPALA (16/136/35)
NIHR Clinical Lectureship (N/A)
UK Medical Research Council (MR/P022081/1)
Identifiers
thoraxjnl-2021-217663
External DOI: https://doi.org/10.1136/thoraxjnl-2021-217663
This record's URL: https://www.repository.cam.ac.uk/handle/1810/333460
Rights
Licence:
http://creativecommons.org/licenses/by-nc/4.0/
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