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Pattern of Abnormalities amongst Chest X‐rays of Adults Undergoing Computer‐Assisted Digital Chest X‐Ray Screening for Tuberculosis in Peri‐Urban Blantyre, Malawi: A Cross‐Sectional Study

Twabi, Hussein H, Semphere, Robina, Mukoka, Madalo, Chiume, Lingstone, Nzawa, Rebecca, R A Feasey, Helena, Lipenga, Trancizeo, MacPherson, Peter ORCID:, Corbett, Elizabeth L and Nliwasa, Marriott (2021) 'Pattern of Abnormalities amongst Chest X‐rays of Adults Undergoing Computer‐Assisted Digital Chest X‐Ray Screening for Tuberculosis in Peri‐Urban Blantyre, Malawi: A Cross‐Sectional Study'. Tropical Medicine & International Health, Vol 26, Issue 11, pp. 1427-1437.

Twabi-2021-Pattern-of-abnormalities-amongst-ch.pdf - Accepted Version

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The prevalence of diseases other than tuberculosis (TB) detected during chest x-ray screening is poorly described in sub-Saharan Africa. Computer-assisted digital chest x-ray technology is available for TB screening and has potential to be a screening tool for non-communicable diseases as well. Low- and middle-income countries are in a transition period where the burden of noncommunicable diseases is increasing but health systems are mainly focused on addressing infectious diseases.

Participants were adults undergoing computer-assisted chest x-ray screening for tuberculosis in a community-wide tuberculosis prevalence survey in Blantyre, Malawi. Adults with abnormal radiographs by Field Radiographer interpretation were evaluated by a physician in a community-based clinic. X-ray classifications were compared to classifications of a random sample of normal chest x-rays by radiographer interpretation. Radiographic features were classified using WHO Integrated Management for Adult Illnesses (IMAI) guidelines. All radiographs taken at the screening tent were analysed by the qXR v2.0 software.

5% (648/13,490) of adults who underwent chest radiography were identified to have an abnormal chest x-ray by the radiographer. 387 (59.7%) of the participants attended the x-ray clinic and another 387 randomly sampled normal x-rays were available for comparison. Participants who were referred to the community clinic had a significantly higher HIV prevalence than those who had been identified to have a normal CXR by the field radiographer (90 [23.3%] versus 43 [11.1%] p-value <0.001). The commonest radiographic finding was cardiomegaly (20.7%, 95% CI 18.0-23.7). One in five (81/387) chest x-rays were misclassified by the radiographer. The overall mean qXR v2.0 score for all reviewed x-rays was 0.23 (SD 0.20). There was a high concordance of cardiomegaly classification between the physician and the computer-assisted software (109/118, 92.4%).

There is a high burden of cardiomegaly on chest x-ray at community level, much of which is in patients with diabetes, heart disease and high blood pressure. Cardiomegaly on chest x-ray may be a potential tool for screening for cardiovascular NCDs at primary care level as well as in the community.

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 220 Diagnosis. Prognosis
WF Respiratory System > Tuberculosis > WF 225 Mass chest X-ray
Faculty: Department: Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI):
Depositing User: Stacy Murtagh
Date Deposited: 27 Jul 2021 14:17
Last Modified: 23 Jul 2022 01:02


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