Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study

Tesfahunegn Hailemariam; Getnet Yimer; Hussen Mohammed; Haileleul Bisrat; Tigist Ajeme; Merga Belina; Lemessa Oljira; Kedir Teji Roba; Fekadu Belay; Tsion Andrias; Esther Ngadaya; Tsegahun Manyazewal

doi:10.1016/j.jctube.2023.100383

Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study

J Clin Tuberc Other Mycobact Dis. 2023 Jun 8:32:100383. doi: 10.1016/j.jctube.2023.100383. eCollection 2023 Aug.

Authors

Tesfahunegn Hailemariam^{1

2}, Getnet Yimer^{1

3}, Hussen Mohammed⁴, Haileleul Bisrat¹, Tigist Ajeme¹, Merga Belina¹, Lemessa Oljira⁵, Kedir Teji Roba⁶, Fekadu Belay⁷, Tsion Andrias⁸, Esther Ngadaya⁹, Tsegahun Manyazewal¹

Affiliations

¹ Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia.
² Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia.
³ Center for Global Genomics and Health Equity, Department of Genetics, Perelman School of Medicine, University of Pennsylvania, USA.
⁴ Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia.
⁵ School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁶ School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
⁷ Wachemo University, College of Medicine and Health Sciences, Department of Pediatrics and Child Health, Hossana, Ethiopia.
⁸ Ethiopian Hospitals Association, Ethiopia.
⁹ National Institute for Medical Research, Muhimbili Research Centre, Dar es Saalam, Tanzania.

Abstract

Background: Tuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms.

Methods: We consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth's multivariate-penalized logistic regression model.

Results: We enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus (P-value = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20-57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25-12.29]) were associated with bacteriologically-confirmed TB cases.

Conclusions: We found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.

Keywords: Acute respiratory symptoms; Chest X-ray; EXIT-TB; Ethiopia; Pulmonary tuberculosis; Women of reproductive age.