It's not TB but what could it be? Abnormalities on chest X-rays taken during the Kenya National Tuberculosis Prevalence Survey

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 quantify and characterise 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 diagnosis. 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 diagnosis, we identified a wide variety of non-TB diagnoses during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts. Funding National Institute for Health Research (IMPALA-grant reference 16/136/35).

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Evidence for pulmonary rehabilitation in chronic respiratory diseases in sub-Saharan Africa: a systematic review

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0526 ◽

2020 ◽

Vol 24 (10) ◽

pp. 991-999

Author(s):

F. M. Bickton ◽

C. Fombe ◽

E. Chisati ◽

J. Rylance

Keyword(s):

Pulmonary Rehabilitation ◽

Respiratory Diseases ◽

Sub Saharan Africa ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Chronic Respiratory Diseases ◽

Exercise Regimen ◽

Home Based ◽

Sub Saharan ◽

Randomised Controlled

BACKGROUND: Pulmonary rehabilitation (PR) is a highly effective non-pharmacological treatment for patients with chronic respiratory diseases.OBJECTIVE: To synthesise the evidence for PR practice and efficacy in sub-Saharan Africa.METHODS: We searched in PubMed and Scopus for relevant studies and scanned reference lists of relevant studies from these databases for additional studies. Articles meeting the inclusion criteria were included. Pre-determined data were extracted independently by two reviewers. A narrative synthesis approach was used in the interpretation of findings.RESULTS: Six studies were included, totalling 275 participants. Indications for PR were chronic obstructive pulmonary disease, asthma, pulmonary tuberculosis and post-tuberculosis lung disease. Programmes ran for 6–12 weeks, universally incorporated exercise, and variously used home-based and hospital-based delivery models. All were interventional studies, of which two were randomised controlled trials, and primarily reported pulmonary function and exercise tolerance endpoints. Evidence for individualising the exercise regimen was available in three studies.CONCLUSIONS: There is limited evidence on PR design and efficacy in sub-Saharan Africa, but available data support its use in a variety of chronic respiratory conditions. Future studies should report core outcome sets and their individualised exercise and education regimens.

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Availability and affordability of medicines and diagnostic tests recommended for management of asthma and chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-019-0329-2 ◽

2019 ◽

Vol 15 (1) ◽

Cited By ~ 2

Author(s):

Davis Kibirige ◽

Richard E. Sanya ◽

Rebecca Nantanda ◽

William Worodria ◽

Bruce Kirenga

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Diagnostic Tests ◽

Sub Saharan Africa ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Sub Saharan

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Prevalence of COPD among women and relation with cooking fuel choice in Ouagadougou, Burkina Faso

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0609 ◽

2020 ◽

Vol 24 (9) ◽

pp. 928-933

Author(s):

A. Sana ◽

N. Meda ◽

B. Kafando ◽

G. Badoum ◽

C. Bouland

Keyword(s):

Chronic Bronchitis ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Sub Saharan Africa ◽

Chronic Obstructive ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Sub Saharan ◽

Test Result ◽

Urgent Action

BACKGROUND: According to the WHO, chronic obstructive pulmonary disease (COPD) will become the third leading cause of death by 2030. In sub-Saharan Africa, the burden of the disease is unknown. We assessed the prevalence and the factors associated with COPD and chronic bronchitis among women in charge of household cooking.METHODS: A cross-sectional population survey was conducted. We randomly selected women aged ≥18 years in charge of cooking in their household. COPD was defined as post-bronchodilator FEV1/FVC (forced expiratory volume in 1 sec/forced vital capacity) ratio of <0.70; chronic bronchitis was defined as cough with sputum of at least 3 months in the year for at least 2 consecutive years.RESULTS: Of the 1705 women interviewed, 835 were selected to perform spirometry and 564 provided an acceptable test result. The prevalence of COPD was 1.1% and that of chronic bronchitis was 1.2%. COPD prevalence was higher among women using biomass, women aged >40 years, those had been cooking or had been exposed to toxic gases for more than 30 years. After adjustment, only biomass fuel use and exposure to toxic products were found to be associated with COPD.CONCLUSION: Urgent action is need to accelerate the transition to the other sources of energy.

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

Thorax ◽

10.1136/thoraxjnl-2020-216123 ◽

2021 ◽

pp. thoraxjnl-2020-216123

Author(s):

Brenda Nyambura Mungai ◽

Elizabeth Joekes ◽

Enos Masini ◽

Angela Obasi ◽

Veronica Manduku ◽

...

Keyword(s):

Population Based ◽

Sub Saharan Africa ◽

Radiological Findings ◽

Prevalence Survey ◽

X Ray ◽

Chest X Ray ◽

Sub Saharan ◽

Significant Disease ◽

Tuberculosis Prevalence ◽

Missed Opportunity

BackgroundThe prevalence of diseases other than 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.MethodsWe 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% CIs of abnormalities diagnosis were estimated.FindingsCardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.InterpretationBased 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.FundingNational Institute for Health Research (IMPALA-grant reference 16/136/35).

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