TB more prevalent in Uganda than previously estimated: Highlights of the Uganda National TB prevalence survey 2014 – 2016

On 24 August 2017, the Ministry of Health released findings of the national TB survey. Until 2016 the true burden of tuberculosis in Uganda was unknown. WHO estimated prevalence of 159 per 100,000 in 2014 based on health facility data and modeling [1]. A cross sectional national population based survey of persons in selected clusters was conducted between 2014 and 2015 to determine the prevalence of bacteriologically confirmed pulmonary TB (PTB) in the population aged >15 years and associated factors.

Participants’ were screened using a combined TB symptoms’ and chest x-rays (CXR) strategy. Those with positive screening submitted two sputum samples which were subjected to TB laboratory tests (smear, GeneXpert and culture). A panel of TB experts ascertained the TB status of suspected patients using TB symptoms, CXR and laboratory findings. A total of 70 clusters located in 57 districts of Uganda with a sample size of 41,154 were screened for TB. Of these, 12.5% had either chest x-ray signs or symptoms suggestive of TB (screen positives).

The prevalence of bacteriologically confirmed TB among individuals aged >15 years was 401/100,000(95% Confidence Interval (CI) = 292 – 509). TB was more prevalent in urban 504/100000 (95% CI=355 – 652) than rural areas 370/100000 (95% CI = 237 – 504) and 4 times more prevalent in males 734/100000 (95% CI=554 – 914) than females 178/100000 (95% CI=109 – 247). On adjusting for age, bacteriologically negative and extra pulmonary TB, prevalence of PTB in Uganda was estimated at 253/100000 (95% CI=191 – 315). Tuberculosis is more prevalent than previously thought. About half of all the expected TB patients are missed. Gov- ernment of Uganda, donors, partners and all stakeholders should support Ministry of Health to design and implement robust a strategic plan to tackle the TB epidemic in Uganda.

Reference

1. World Health Organization: Global Tuberculosis Report 2015, 20th Geneva: World Health Organization; 2015.