Evidence map›Paper›PMID 33588804›Full record

ArticleBMC infectious diseases2021

Tuberculosis diagnosis cascade in Blantyre, Malawi: a prospective cohort study.

Helena R A Feasey, Elizabeth L Corbett, Marriott Nliwasa, Luke Mair, Titus H Divala, Wala Kamchedzera, Mc Ewen Khundi, Helen E D Burchett, Emily L Webb, Hendramoorthy Maheswaran and 2 more

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Article in BMC infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
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  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Helena R A FeaseyMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi. helena.feasey@lshtm.ac.uk.ORCID http://orcid.org/0000-0003-3109-6722
Elizabeth L CorbettMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Marriott NliwasaHelse Nord Tuberculosis Initiative, College of Medicine, University of Malawi, Blantyre, Malawi.
Luke MairLiverpool School of Tropical Medicine, Liverpool, UK.
Titus H DivalaLondon School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, UK.
Wala KamchedzeraMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Mc Ewen KhundiMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
Helen E D BurchettLondon School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, UK.
Emily L WebbLondon School of Hygiene & Tropical Medicine, Keppel Street, Bloomsbury, London, UK.
Hendramoorthy MaheswaranUniversity of Liverpool, Liverpool, UK.
S Bertel SquireLiverpool School of Tropical Medicine, Liverpool, UK.
Peter MacPhersonMalawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.

Funding

Medical Research Council MR/K012126/1Medical Research Council MR/R010161/1MRF MR/K012126/1Wellcome TrustWellcome Trust 206575/Z/17/Z
6 · The paper itself

Abstract

backgroundTuberculosis (TB) control relies on early diagnosis and treatment. International guidelines recommend systematic TB screening at health facilities, but implementation is challenging. We investigated completion of recommended TB screening steps in Blantyre, Malawi.

methodsA prospective cohort recruited adult outpatients attending Bangwe primary clinic. Entry interviews were linked to exit interviews. The proportion of participants progressing through each step of the diagnostic pathway were estimated. Factors associated with request for sputum were investigated using multivariable logistic regression.

resultsOf 5442 clinic attendances 2397 (44%) had exit interviews. In clinically indicated participants (n = 445) 256 (57.5%) were asked about cough, 36 (8.1%) were asked for sputum, 21 (4.7%) gave sputum and 1 (0.2%) received same-day results. Significant associations with request for sputum were: any TB symptom (aOR:3.20, 95%CI:2.02-5.06), increasing age (aOR:1.02, 95%CI:1.01-1.04 per year) and for HIV-negative participants only, a history of previous TB (aOR:3.37, 95%CI:1.45-7.81). Numbers requiring sputum tests (26/day) outnumbered diagnostic capacity (8-12/day).

conclusionsPatients were lost at every stage of the TB care cascade, with same day sputum submission following all steps of the diagnosis cascade achieved in only 4.7% if clinically indicated. Infection control strategies should be implemented, with reporting on early steps of the TB care cascade formalised. High-throughput screening interventions, such as digital CXR, that can achieve same-day TB diagnosis are urgently needed to meet WHO End TB goals.

Indexed as

AdolescentAdultAgedAged, 80 and overAmbulatory Care FacilitiesFemaleHumansInterviews as TopicLogistic ModelsMalawiMaleMass ScreeningMiddle AgedMycobacterium tuberculosisProspective StudiesSputum

Identifiers

PMID33588804
PMCPMC7883960

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.