The yield of chest X-ray based versus symptom-based screening among patients with diabetes mellitus in public health facilities in Addis Ababa, Ethiopia

Degu Jerene; Chaltu Muleta; Solomon Dressie; Abdurezak Ahmed; Getahun Tarekegn; Tewodros Haile; Ahmed Bedru; Gidado Mustapha; Agnes Gebhard; Fraser Wares

doi:10.1016/j.jctube.2022.100333

The yield of chest X-ray based versus symptom-based screening among patients with diabetes mellitus in public health facilities in Addis Ababa, Ethiopia

J Clin Tuberc Other Mycobact Dis. 2022 Oct 5:29:100333. doi: 10.1016/j.jctube.2022.100333. eCollection 2022 Dec.

Authors

Affiliations

¹ KNCV Tuberculosis Foundation, Division of TB Elimination and Health Systems Innovation, The Hague, the Netherlands.
² KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia.
³ Addis Ababa City Administration Regional Health Bureau, Disease Prevention and Control, Addis Ababa, Ethiopia.
⁴ Addis Ababa University, Tikur Anbessa Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, Ethiopia.
⁵ Addis Ababa University, Tikur Anbessa Specialized Hospital, Department of Internal Medicine, Pulmonary and Critical Care Medicine Unit, Addis Ababa, Ethiopia.

Abstract

Background: Patients with diabetes mellitus (DM) are at increased risk of developing TB, but the best screening algorithm for early detection and treatment of TB remains unknown. Our objective was to determine if combining routine chest X-ray screening could have a better yield compared with symptom-based screening alone.

Methods: We conducted this cross-sectional study between September 2020 and September 2021 in 26 public health facilities in Addis Ababa, Ethiopia. All DM patients attending the clinics during the study period were offered chest X-ray and symptom screening simultaneously followed by confirmatory Xpert testing. We analyzed the number and proportion of patients with TB by the diagnostic algorithm category and performed binary logistic regression analysis to identify predictors of TB diagnosis.

Results: Of 7394 patients screened, 54.6 % were female, and their median age was 53 years. Type-2 diabetes accounted for 89.6 % of all participants of the patients. Of 172 symptomatic patients, chest X-ray suggested TB in 19, and 11 of these were confirmed to have TB (8 bacterilogicially confirmed and 3 clinically diagnosed). Only 2 of the 152 asymptomatic patients without X-ray findings had TB (both bacteriologically confirmed). X-ray was not done for one patient. On the other hand, 28 of 7222 symptom-negative patients had X-ray findings suggestive of TB, and 7 of these were subsequently confirmed with TB (6 clinically diagnosed). When combined with 8 patients who were on treatment for TB at the time of the screening, the overall point prevalence of TB was 380 per 100,000. The direct cost associated with the X-ray-based screening was 42-times higher.

Conclusion: Chest X-ray led to detection of about a third of TB patients which otherwise would have been missed but the algorithm is more expensive. Its full cost implication needs further economic evaluation.

Keywords: Diabetes; Ethiopia; Screening; Symptom-based; Tuberculosis; chest Xray.