‘If not TB, what could it be?’ Chest X-ray findings from the 2016 Kenya Tuberculosis Prevalence Survey

Source: This abstract has been sourced from NZ Respiratory Research Review Issue 187

ABSTRACT

Background The prevalence of diseases other than
TB detected during chest X-ray (CXR) screening is
unknown in sub-Saharan Africa. This represents a missed
opportunity for identification and treatment of potentially
significant disease. Our aim was to describe and quantify
non-TB abnormalities identified by TB-focused CXR
screening during the 2016 Kenya National TB Prevalence
Survey.
Methods We reviewed a random sample of 1140 adult
(≥15 years) CXRs classified as ’abnormal, suggestive
of TB’ or ’abnormal other’ during field interpretation
from the TB prevalence survey. Each image was read
(blinded to field classification and study radiologist
read) by two expert radiologists, with images classified
into one of four major anatomical categories and
primary radiological findings. A third reader resolved
discrepancies. Prevalence and 95% CIs of abnormalities
diagnosis were estimated.
Findings Cardiomegaly was the most common nonTB abnormality at 259 out of 1123 (23.1%, 95% CI
20.6% to 25.6%), while cardiomegaly with features of
cardiac failure occurred in 17 out of 1123 (1.5%, 95%
CI 0.9% to 2.4%). We also identified chronic pulmonary
pathology including suspected COPD in 3.2% (95% CI
2.3% to 4.4%) and non-specific patterns in 4.6% (95%
CI 3.5% to 6.0%). Prevalence of active-TB and severe
post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%)
and 1.4% (95% CI 0.8% to 2.3%), respectively.
Interpretation Based on radiological findings, we
identified a wide variety of non-TB abnormalities during
population-based TB screening. TB prevalence surveys
and active case finding activities using mass CXR offer
an opportunity to integrate disease screening efforts.
Funding National Institute for Health Research
(IMPALA-grant reference 16/136/35).

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