Kenya tuberculosis prevalence survey 2016: Challenges and opportunities of ending TB in Kenya

We aimed to determine the prevalence of pulmonary TB amongst the adult population (≥15 years) in 2016 in Kenya. A nationwide cross-sectional survey where participants first underwent TB symptom screening and chest x-ray. Subsequently, participants who reported cough >2weeks and/or had a chest x-r...

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Published in:	PloS one Vol. 13; no. 12; p. e0209098
Main Authors:	Enos, Masini, Sitienei, Joseph, Ong'ang'o, Jane, Mungai, Brenda, Kamene, Maureen, Wambugu, Jesse, Kipruto, Hillary, Manduku, Veronica, Mburu, Josephine, Nyaboke, Drusilla, Ngari, Faith, Omesa, Eunice, Omale, Newton, Mwirigi, Nkirote, Okallo, Geoffrey, Njoroge, Janice, Githiomi, Martin, Mwangi, Mike, Kirathe, Dickson, Kiplimo, Richard, Ndombi, Amos, Odeny, Lazarus, Mailu, Eunice, Kandie, Timothy, Maina, Maurice, Kasera, Kadondi, Mulama, Beatrice, Mugi, Beatrice, Weyenga, Herman
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 26-12-2018 Public Library of Science (PLoS)
Subjects:	Adolescent Adult Aged Annual reports Biology and Life Sciences Body weight loss Chemists Chest Cough Cough - etiology Cross-Sectional Studies Disease prevention Female Fever Health care Humans Internet Kenya - epidemiology Leprosy Lung diseases Male Males Medical diagnosis Medical research Medicine and Health Sciences Microscopy Middle Aged Organic chemistry People and Places Prevalence Public health Pulmonary tuberculosis Smear Sputum Sputum - microbiology Statistics Sweat Thorax - diagnostic imaging Tuberculosis Tuberculosis, Pulmonary - diagnosis Tuberculosis, Pulmonary - epidemiology Urban areas Weight loss Young Adult Kenya Uganda United States > US Tanzania
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Summary:	We aimed to determine the prevalence of pulmonary TB amongst the adult population (≥15 years) in 2016 in Kenya. A nationwide cross-sectional survey where participants first underwent TB symptom screening and chest x-ray. Subsequently, participants who reported cough >2weeks and/or had a chest x-ray suggestive of TB, submitted sputum specimen for laboratory examination by smear microscopy, culture and Xpert MTB/RIF. The survey identified 305 prevalent TB cases translating to a prevalence of 558 [95%CI 455-662] per 100,000 adult population. The highest disease burden was reported among people aged 25-34 years (716 [95% CI 526-906]), males (809 [(95% CI 656-962]) and those who live in urban areas (760 [95% CI 539-981]). Compared to the reported TB notification rate for Kenya in 2016, the prevalence to notification ratio was 2.5:1. The gap between the survey prevalence and notification rates was highest among males, age groups 25-34, and the older age group of 65 years and above. Only 48% of the of the survey prevalent cases reported cough >2weeks. In addition, only 59% of the identified cases had the four cardinal symptoms for TB (cough ≥2 weeks, fever, night sweat and weight loss. However, 88.2% had an abnormal chest x-ray suggestive of TB. The use of Xpert MTB/RIF identified 77.7% of the cases compared to smear microscopy's 46%. Twenty-one percent of the survey participants with respiratory symptoms reported to have sought prior health care at private clinics and chemists. Among the survey prevalent cases who reported TB related symptoms, 64.9% had not sought any health care prior to the survey. This survey established that TB prevalence in Kenya is higher than had been estimated, and about half of the those who fall ill with the disease each year are missed.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0209098