Table 1.
Prevalence of Tuberculosis and Characteristics of Screening
| Survey | Crude Prevalence of TB (95%CI), n/100 000 Population | Estimated Incidence (95% CI), n/100 000 Population | Symptom Screening Criteria | X-ray Screening Device | X-ray Screening Criteria | Bacteriological Confirmation Test | Criteria for Eligibility for Bacteriological Examination | Total Number of Individuals Screened | Proportion of Individuals Screened That Is S–X– (%) | Proportion of Individuals Screened That Is S+X– (%) | Proportion of Individuals Screened That Is S+X+ (%) | Proportion of Individuals Screened That Is S–X+ (%) | Other (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bangladesh 2015 | 287 (244–330) | 221 (160–290) | Symptom screening score ≥3 | Digital mobile X ray | Any lung abnormality consistent with TB | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA and symptom score ≥1 | 98 710 | 79.4 | 4.2 | 3.1 | 13.8 | S+XNA 0.04 |
| Cambodia 2002 | 1208 (992–1463) | 600 | Cough ≥3 weeks and/ or hemoptysis in the previous month | Portable X-ray machine | TB-related shadows (active, suspected, and healed TB) or other lung disease, except for those with a single calcification nodule only or a minor pleural adhesion at the costophrenic angle | Smear-positive and/or culture-positive | S+ and/or X+ or XNA | 22 160 | Not reported | 4.6 | 2.6 | 8.2 | Include XNA |
| Cambodia 2011 | 831 (707–977) | Not reported | Cough ≥2 weeks and/or hemoptysis | Portable X-ray machine | Any abnormal shadow in the lung field or mediastinum other than a single small calcification nodule with a size <10 mm or pleural adhesion at the costophrenic angle(s) | Smear-positive and/or culture-positive | S+ and/or X+ or XNA | 37 417 | 87.22 | 3.1 | 1.9 | 7.2 | S–XNA 0.4 S+XNA 0.1 “Other” 0.02 |
| China 2000a | 466 | Not reported | Cough ≥3 weeks and/ or hemoptysis ≥3 weeks | Chest fluoroscopy of all patients, then X ray if they showed abnormal results | Abnormal findings except hilar calcification, a few fibrotic indurated lesions, small area of pleural thickening | Smear positive and/or culture positive | S+ and/or X+ and all known TB cases | 365 097 | Not reported | Not reported | Not reported | Not reported | Not applicable |
| China 2010a | 459 | Not reported | Not reported | Not reported | Not reported | Smear microscopy and culture | S+ and/or X+ and all known TB cases | 25 2940 | Not reported | Not reported | Not reported | Not reported | Not applicable |
| Democratic People’s Republic of Korea 2016 | 567 (510–631) | Not reported | Cough ≥2 weeks and/ or hemoptysis | Portable X-ray machine | Abnormal chest radiograph in the lung field or mediastinum other than a single small calcification nodule with a size <10 mm or pleural adhesion at cost-phrenic angle(s) | Culture-positive | S+ and/or X+ | 60 683 | Not reported | Not reported | 1.7 | 3.1 | S–X– or S–XNA 92 S+X– or S+XNA 3.2 |
| Indonesia 2014 | 759 (589–961) | Not reported | Cough ≥2 weeks and/ or hemoptysis | Digital mobile X ray | Any lung or pleura abnormality | Smear-positive and/or culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 67 944 | 77.3 | 5.7 | 6.6 | 9.9 | S+XNA 0.37 S–XNA with any symptom of TB 0.2 |
| Lao People’s Democratic Republic 2011 | 595 (457–733) | Not reported | Cough ≥2 weeks and/ or hemoptysis in the previous month | Full-size conventional CXR | Any abnormal lung field shadow | Culture-positive | S+ and/or X+ | 39 212 | 83.8 | Not reported | 3.3 | 7.9 | S+X– or S+XNA 4.9 |
| Mongolia 2015 | 559.6 (454.5–664.7) | 428 (220–703) | Cough ≥2 weeks | Digital mobile X ray | Any abnormal shadow in lung field and mediastinum or pleural effusion | Smear-positive and/or culture-positive | S+ and/or X+ or XNA | 50 309 | 79.3 | 3.4 | 1.6 | 14 | S+XNA 0.08 SNA X+ 0.06 SNA XNA 1.5 |
| Myanmar 2009 | 612.8 (502.2–747.6) | 526 (307–802) | Any symptom | Portable X-ray machine | Any abnormality in the lung field or mediastinum greater than a single small calcification nodule or pleural adhesion at the costophrenic angle | Smear-positive and/or culture-positive | S+ and/or X+ or XNA | 51 367 | 76.2 | 0.8 | 2.5 | 18.3 | S–XNA 2.1 S+XNA 0.1 Suspected false-negative CXR 0.1 |
| Philippines 2016 | 1159 (1016–1301) | 554 (311–866) | Cough ≥2 weeks and/ or hemoptysis in the previous month | Mass miniature radiography | Any abnormality suggestive of TB | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 46 689 | 60.2 | 2.8 | 2.9 | 22.9 | S+XNA 0.3 S–XNA 10.9 |
| Thailand 2012b | 142 (166.3–287.8) | Not obtainable | Cough ≥2 weeks | Not obtainable | Not obtainable | Smear-positive and/or culture-positive | Not obtainable | 62 536 | 90.3 | 2.8 | 0.8 | 6 | Includes XNA |
| Vietnam 2007 | 286 | 171 | Cough ≥2 weeks | Either mass miniature radiography or digital mobile X ray | Any abnormality suggestive of TB | Smear-positive and/or culture-positive | S+ and/or X+ or TB current treatment or history of treatment within 2 years | 94 179 | 92.2 | 0.01 | 0.6 | Not reported | SNA and XNA 0.4 S+XNA 3.7 SNA X+ 2.9 |
| Ethiopia 2011 | 277 (208–347) | 258(191–335) | Cough ≥2 weeks | Portable X-ray machine | Any abnormality in lung field or mediastinum, including cavities, infiltrates, pleural effusion, hilar or mediastinal lymphadenopathy, pulmonary nodules, interstitial abnormalities suggestive or TB or healed TB | Culture-positive | S+ and/or X+ | 46 697 | Not reported | Not reported | 1.7 | 6.4 | S–X– or S–XNA 87.1 S+X– or S+XNA 4.7 |
| Gambia 2012 | 179 (149–231) | 175 (132–215) | Cough ≥2 weeks, or cough ≤2 weeks plus ≥2 symptoms suggestive of TB, or no cough but ≥3 symptoms suggestive of TB | Digital mobile X ray | Any abnormality in lung field or mediastinum, including cavities, infiltrates, pleural effusion, hilar or mediastinal lymphadenopathy, pulmonary nodules, interstitial abnormalities suggestive or TB or healed TB | Culture-positive | S+ and/or X+ | 43 100 | Not reported | 5.5 | 2.4 | 5.5 | S+XNA 0.13 S–XNA or S–X– 86.2 |
| Ghana 2013 | 327 (282–347) | Not reported | Cough ≥2 weeks | Digital mobile X ray | Any abnormalities in lung, pleura, mediastinum | Culture-positive and/or Xpert-positive with X+ | S+ and/or X+ or XNA | 61 726 | 86.6 | 1.8 | 1.2 | 7.1 | S+XNA 0.1 S–XNA 3.1 |
| Kenya 2015 | 558 (455–662) | Not reported | Cough ≥2 weeks | Digital mobile X ray | Any finding suggestive of TB | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 63 050 | 84.6 | 4.5 | 2 | 8.2 | S–XNA 0.6 S+XNA 0.5 |
| Malawi 2013c | 452 (312–593) | Not reported | ≥1 week of cough or sputum or blood in sputum or chest pain or weight loss or night sweats or fatigue or fever or shortness of breath | Conventional radiography (film system), portable X-ray generator | Any lung abnormality (opacities, cavitation, fibrosis, calcification) | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 31 579 | 88.8 | 7.4 | 1.2 | 2.3 | S+XNA 0.2 S–XNA 0.03 missed 0.2 |
| Namibia 2017 | 431 (361.4–514.3) | Not reported | Cough or weight loss or fever or night sweats | Portable X-ray machine | Any abnormality suggestive of TB, read by automatic software and radiologist | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 29 495 | 63.2 | 14 | 5.8 | 11.3 | S+XNA 1.5 S–XNA 4.3 |
| Nigeria 2012 | 524 (378–670) | 108 (50–186) | Cough ≥2 weeks | Mass miniature radiography | Any abnormality suggestive of TB | Smear-positive and/or culture-positive | S+ and/or X+ or XNA | 44 186 | Not reported | Not reported | 1.7 | 5 | S–X– or S–XNA 89.4 S+X– or S+XNA 3.9 |
| Rwanda 2012 | 119.3 (78.8–159.9) | Not reported | Cough any duration | Not reported | Any abnormality suggestive of TB | Culture-positive | S+ and/or X+ or XNA | 43 128 | 88.8 | 4.8 | 1.3 | 4.9 | S+ XNA 0.02 S– XNA 0.1 SNA X– 0.02 |
| Sudan 2014 | 183.4 (129.6–237.2) | Not reported | Cough ≥2 weeks | Digital mobile X ray | Any lung abnormality, including pleura | Culture-positive and/or NAAT-positive | S+ and/or X+ or XNA or TB current treatment | 83 202 | 78.2 | Not reported | 2.2 | Not reported | S–X– or SNA XNA 0.7 SNA XNA 0.13 S+XNA or S+X– 0.8 S–X+ or SNA X+ 11.6 S–XNA 6.3 |
| Tanzania 2012 | 307 (261–360) | Not reported | Cough ≥2 weeks or hemoptysis or fever ≥2 weeks or weight loss or excessive sweating | Digital mobile X ray | Any abnormalities in the lung field or mediastinum | Culture-positive | S+ and/or X+ or XNA | 50 447 | 87.5 | 6.4 | 1.7 | 3.7 | S+XNA 0.6 SNAX+ 0.08 |
| Uganda 2014 | 401 (292–509) | Not reported | Cough ≥2 weeks | Digital mobile X ray | Any abnormalities in lung | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 41 154 | 87.5 | 5.2 | 1.3 | 5.6 | XNA 0.4 |
| Zambia 2014 | 638 (505–774) | Not reported | Cough ≥2 weeks or fever ≥2 weeks or chest pain ≥2 weeks | Digital mobile X ray | Any lung abnormality excluding heart and bone abnormality | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 46 099 | 84.2 | 6.3 | 3.6 | 4.9 | S+XNA 0.09 S–XNA 1.2 |
| Zimbabwe 2014 | 317.1 (250.5–383.8) | Not reported | Any symptom | Digital mobile X ray | Any abnormalities in lung | Culture-positive and/or Xpert-positive | S+ and/or X+ or XNA | 33 736 | 82.7 | 3.4 | 1.9 | 8.3 | S–XNA 3.5 S+XNA 0.1 “other” 0.03 |
A list of references for included prevalence surveys is available in Supplementary Materials Appendix 1.
Abbreviations: CI, confidence interval; CXR, chest X ray; NA, not applicable, NAAT, nucleic acid amplification tests; used when results for symptom (SNA) or X-ray screening (XNA) were not available; S, symptoms; TB, tuberculosis; X, X ray.
aSurveys from China were excluded from the analysis because results active pulmonary cases, of which the proportion of bacteriologically negative clinically diagnosed cases is unknown.
b Some data were not obtainable from Thailand in 2012 because the only version of the survey report was in Thai.
cMalawi 2013: results were excluded from the analysis because the quality of images observed in some clusters was substandard and could not be compared with results from other countries [10].