disease diagnosis

To assess the use of Xpert for accurate diagnosis, timely initiation, and rational use of anti-TB treatment among childhood TB patients, we reviewed data trends over four consecutive years; two years before the arrival of the machine and two years following the implementation of Xpert. During the intervention period (2016–2017), 371 children with presumptive TB were evaluated using Xpert. A total of 199 (53.6%) childhood TB cases were notified, of which 88 (44.2%) were Xpert positive and 111 (55.8%) were treated as Xpert-negative probable TB cases. The tendency to initiate anti-TB treatment for unconfirmed TB cases was reduced by a third. Compared with smear AFB, Xpert improved accuracy of diagnosing pediatric TB cases two-fold. The average waiting time to start anti-TB treatment was 1.33 days. There was a significant reduction in the waiting time to start anti-TB treatment, with a mean time difference before and during intervention of 5.62 days. Xpert use was associated with a significant increase in the accuracy of identifying confirmed TB cases, reduced unnecessary anti-TB prescription, and shortened the time taken to start TB treatment.

To describe trends in diagnostic and treatment delays and estimate their effect on  rifampicin-resistant tuberculosis (RR-TB) mortality, we conducted a retrospective analysis of individual-level data including 748 (85.4%) of 876 patients diagnosed with RR-TB notified to the World Health Organization between 1 July 2005 and 31 December 2016 in Rwanda. Logistic regression was used to estimate the effect of diagnostic and therapeutic delays on RR-TB mortality. Between 2006 and 2016, the median diagnostic delay significantly decreased from 88 days to 1 day, and the therapeutic delay from 76 days to 3 days. Simultaneously, RR-TB mortality significantly decreased from 30.8% in 2006 to 6.9% in 2016.

A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Between onset of illness and anti-TB treatment course, patients incurred a median of US$201.48. Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median of US$97.62 and US$93.75 during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median of US$21.64 and US$35.02. Patient delay days, provider delay days, number of healthcare facilities visited until TB diagnosis, and TB diagnosis at private facilities independently predicted increased pre-diagnosis cost. Similarly, rural residence, hospitalization during anti-TB treatment, patient delay days, and provider delay days predicted increased post-diagnosis costs. TB patients incur substantial cost for care seeking and treatment despite “free service” for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

Quality of tuberculosis (TB) microscopy diagnosis is not a guarantee despite implementation of external quality assurance (EQA) services in all laboratories of health facilities. Hence, we aimed at evaluating the technical quality and the findings of sputum smear microscopy for acid fast bacilli (AFB) at health centers in Hararge Zone, Oromia Region, Ethiopia. Of the total 55 health center laboratories assessed during the study period (July 2014-July 2015), 20 (36.4%) had major technical errors; 13 (23.6%) had 15 false negative results and 17 (30.9%) had 22 false positive results. The quality of AFB smear microscopy reading and smearing was low in most of the laboratories of the health centers. Therefore, it is essential to strength the EQA program through building the capacity of laboratory professionals.

Our objective was to assess the knowledge of health professionals on Xpert MTB/RIF assay and associated factors in detecting TB/TB drug resistance. An institution based cross–sectional study was conducted from April 4 to June 5, 2015, in Addis Ababa, that involved 209 healthcare providers working in TB clinics.The overall magnitude of knowledge of healthcare workers on Xpert was found to be low. Health workers above age 35 years and those who had read the guidelines on Xpert had greater knowledge of Xpert. Distribution of the national guidelines on Xpert and assigning experienced clinicians to TB DOTs clinics are recommended.

This study compared the yield of TB among contacts of multidrug-resistant tuberculosis (MDR-TB) index cases with that of drug-sensitive TB (DS-TB) index cases in a program setting. The yield of TB among contacts of MDR-TB and DS-TB using GeneXpert was high as compared to population-level prevalence. The likelihood of diagnosing RR (Rifampicin Resistant)-TB among contacts of MDR-TB index cases is higher in comparison with contacts of DS-TB index cases. The use of GeneXpert in DS TB contact investigation has an added advantage of diagnosing RR cases in contrast to using the nationally recommended AFB microscopy for DS TB contact investigation.

In low income countries, Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment for tuberculosis.The objective of this study was to investigate the role of AFB microscopy refresher training on the performance of laboratory professionals in Ethiopia. Training has improved theoretical and practical performance of laboratory professionals. Pre-placement and continuous training irrespective of lab professionals' qualifications and service year and sustainable external quality assessment are highly recommended to ensure quality of AFB microscopy services.

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