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

Mungai, Brenda, Joekes, Elizabeth, Masini, Enos, Obasi, Angela ORCID: https://orcid.org/0000-0001-6801-8889, Manduku, Veronica, Mugi, Beatrice, Ong'ango, Jane, Kirathe, Dickson, Kiplimo, Richard, Sitienei, Joseph, Oronje, Rose, Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and MacPherson, Peter ORCID: https://orcid.org/0000-0002-0329-9613 (2021) '‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey'. Thorax, Vol 76, Issue 6, pp. 607-614.

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Abstract

Background:
The prevalence of diseases other than tuberculosis (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% confidence intervals of abnormalities diagnosis were estimated.

Findings:
Cardiomegaly was the most common non-TB abnormality at 259/1123 (23∙1%, 95% CI 20∙6%-25∙6%), while cardiomegaly with features of cardiac failure occurred in 17/1123 (1∙5 %, 95% CI 0.9%-2∙4%). We also identified chronic pulmonary pathology including suspected chronic obstructive pulmonary disease in 3∙2% (95% CI 2∙3%- 4∙4%) and non-specific patterns in 4∙6% (95% CI 3∙5%-6∙0%). Prevalence of active-TB and severe post-TB lung changes was 3∙6% (95% CI 2∙6%- 4∙8%) and 1∙4% (95% CI 0∙8%- 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.

Item Type:	Article
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General) WF Respiratory System > Tuberculosis > WF 225 Mass chest X-ray
Faculty: Department:	Biological Sciences > Department of Tropical Disease Biology Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/thoraxjnl-2020-216123
Depositing User:	Elly Wallis
Date Deposited:	28 Jan 2021 13:12
Last Modified:	05 Jul 2021 11:19
URI:	https://archive.lstmed.ac.uk/id/eprint/16574

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