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Jayasooriya, S. orcid.org/0000-0002-1147-5744, Dimambro-Denson, F., Beecroft, C. orcid.org/0000-0003-1453-0013 et al. (7 more authors) (2023) Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis : a systematic review and meta-analysis. Thorax, 78 (1). pp. 50-60. ISSN 0040-6376
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 Author(s) (or their employer(s)). This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
Keywords: | tuberculosis; respiratory infection; clinical epidemiology |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number Medical Research Council MR/P022081/1 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 21 Feb 2022 07:37 |
Last Modified: | 25 Jun 2024 11:04 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Refereed: | Yes |
Identification Number: | 10.1136/thoraxjnl-2021-217663 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:183802 |
Available Versions of this Item
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Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis. (deposited 31 Jan 2023 11:19)
- Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis : a systematic review and meta-analysis. (deposited 21 Feb 2022 07:37) [Currently Displayed]