학술논문
High TB burden and low notification rates in the Philippines: The 2016 national TB prevalence survey.
Document Type
Article
Author
Lansang, Mary Ann D.; Alejandria, Marissa M.; Law, Irwin; Juban, Noel R.; Amarillo, Maria Lourdes E.; Sison, Olivia T.; Cruz, Jose Rene B.; Ang, Concepcion F.; Buensalido, Joseph Adrian L.; Cañal, Johanna Patricia A.; Castillo-Carandang, Nina T.; Cordero, Cynthia P.; Gaviola, Donna Mae G.; Ladia, Mary Ann J.; Mantaring III, Jacinto Blas V.; Mendoza, Myrna T.; Salamat, Maria Sonia S.; Lam, Hilton Y.; Tadolini, Marina; Garfin, Anna Marie Celina G.
Source
Subject
*SPUTUM examination
*TUBERCULOSIS
*CLUSTER sampling
*PATIENT-centered care
*COUGH
*TUBERCULOSIS in cattle
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Language
ISSN
1932-6203
Abstract
Setting: The 3rd national tuberculosis (TB) survey in the Philippines in 2007 reported a significant decline in the prevalence of TB. Since then, more significant investments for TB control have been made, yet TB burden estimates from routine surveillance data remain relatively stable. Objective: To estimate the prevalence of bacteriologically confirmed pulmonary TB in the Philippines amongst individuals aged ≥15 years in 2016. Design: In March–December 2016, we conducted a population-based survey with stratified, multi-stage cluster sampling of residents in 106 clusters aged ≥15 years. Survey participants were screened for TB by symptom-based interview and digital chest X-ray. Those with cough ≥2 weeks and/or haemoptysis and/or chest X-ray suggestive of TB were requested to submit 2 sputum specimens for Xpert MTB/RIF, direct sputum smear microscopy using LED fluorescent microscopy, and mycobacterial solid culture (Ogawa method). Bacteriologically confirmed pulmonary TB was defined as MTB culture positive and/or Xpert positive. Results: There were 46,689 individuals interviewed, and 41,444 (88.8%) consented to a chest X-ray. There were 18,597 (39.8%) eligible for sputum examination and 16,242 (87.3%) submitted at least one specimen. Out of 16,058 sputum-eligible participants, 183 (1.1%) were smear-positive. There were 466 bacteriologically confirmed TB cases: 238 (51.1%) Xpert positive, 69 (14.8%) culture positive, and 159 (34.1%) positive by both Xpert and culture. The estimated TB prevalence per 100,000 population aged ≥15 years was 434 (95% CI: 350−518) for smear-positive TB, and 1,159 (95% CI: 1,016−1,301) for bacteriologically confirmed TB. Conclusion: This nationally representative survey found that the TB burden in the Philippines in 2016 was higher than estimated from routine TB surveillance data. There was no evidence of a decline in smear and culture positive TB from the 2007 survey despite significant investments in TB control. New strategies for case-finding and patient-centered care must be intensified and expanded. [ABSTRACT FROM AUTHOR]