Population Based National Tuberculosis Prevalence Survey among Adults (>15 Years) in Pakistan, 2010-2011

PLoS One. 2016 Feb 10;11(2):e0148293. doi: 10.1371/journal.pone.0148293. eCollection 2016.

Abstract

Background: We aimed to determine the prevalence of pulmonary tuberculosis (TB) amongst the adult population in 2010-2011 in Pakistan.

Method: A nationwide cross-sectional survey with multistage cluster sampling was conducted among adults (≥15 years) in 95 clusters in 2010-2011. All consenting participants were screened for cough and by chest X-ray. Participants with presumptive TB submitted two sputum samples for smear microscopy, culture, and molecular testing if needed. The TB prevalence estimates were adjusted for missing data and the cluster design.

Result: Of 131,329 eligible individuals, 105,913 (81%) participated in the survey, of whom 10,471 (9.9%) were eligible for sputum examination. We found 341 bacteriologically positive TB cases of whom 233 had sputum smear-positive TB. The adjusted prevalence estimates for smear and bacteriologically positive TB were 270/100,000 (95% confidence interval (CI) 217-323), and 398/100,000 (95% CI 333-463), respectively. Only 61% of the diagnosed TB cases screened positive on symptoms (cough >2wks), whereas the other TB cases were detected based on X-ray abnormalities. The TB prevalence increased with age and was 1.8 times higher among men than women. The prevalence-to-notification ratio of smear-positive TB was 3.1 (95% CI 2.5-3.7), was higher among men than women, and increased with age.

Conclusion: Our data suggest that there is under-detection and/or -notification of TB, especially among men and elderly. TB control should be strengthened specifically in these risk groups. X-ray examination should be combined with symptom screening to enhance case detection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cluster Analysis
  • Cough
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Microscopy
  • Middle Aged
  • Mycobacterium tuberculosis
  • Pakistan / epidemiology
  • Prevalence
  • Quality Control
  • Radiography, Thoracic
  • Sputum / microbiology
  • Surveys and Questionnaires
  • Tuberculosis, Pulmonary / diagnostic imaging
  • Tuberculosis, Pulmonary / epidemiology*
  • Tuberculosis, Pulmonary / microbiology
  • Young Adult

Grants and funding

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of TB CARE I and do not necessarily reflect the views of USAID or the United States Government. KIT Biomedical Research provided support in the form of a salary for author MS, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.