Patients with presumed tuberculosis in sub-Saharan Africa that are not diagnosed with tuberculosis: a systematic review and meta-analysis

Clinical Research Results Abstract INTRODUCTION: A disproportionately high burden of morbidity and mortality due to chronic respiratory disease is born by low- and middle-income countries.1 Many patients in sub-Saharan Africa whom a diagnosis of tuberculosis is considered are subsequently not diagnosed with tuberculosis. The proportion of patients this represents, and their alternative diagnoses, have not previously been systematically reviewed. METHODS: We searched four databases (Ovid Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and the Cochrane library) from inception to 27 April 2020, without language restrictions. We included all adult pulmonary tuberculosis diagnostic studies from sub Saharan Africa, excluding case series and inpatient studies. We extracted the proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis and any alternative diagnoses received. We conducted a random effects meta-analysis to obtain pooled estimates stratified by passive and active case finding. PROSPERO registration number CRD42018100004.RESULTS:Our search identified 1799 studies, of which 18 studies (2002–2019) with 14 527 participants from 10 African countries were included. The proportion of patients with presumed tuberculosis subsequently not diagnosed with tuberculosis was 48.5% (95% CI 39.0 to 58.0) in passive and 92.8% (95% CI 85.0 to 96.7) in active case-finding studies. This proportion increased with declining numbers of clinically diagnosed tuberculosis cases. A history of tuberculosis was documented in 55% of studies, with just five out of 18 reporting any alternative diagnoses. DISCUSSION: Nearly half of all patients with presumed tuberculosis in sub-Saharan Africa do not have a final diagnosis of active tuberculosis. This proportion may be higher when active case-finding strategies are used. Little is known about the primary healthcare needs of these patients. Research is required to better characterise these patient populations in sub Saharan Africa and plan primary care health system solutions that meet their needs. No competing interests to declareReferences: Meghji J, Mortimer K, Agusti A, et al. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest References and Clinical Trial Registry Information