Smear positivity in paediatric and adult tuberculosis: systematic review and meta-analysis
Open Access
- 13 June 2016
- journal article
- review article
- Published by Springer Science and Business Media LLC in BMC Infectious Diseases
- Vol. 16 (1), 1-9
- https://doi.org/10.1186/s12879-016-1617-9
Abstract
Tuberculosis (TB) diagnosis continues to rely on sputum smear microscopy in many settings. We conducted a meta-analysis to estimate the percentage of children and adults with tuberculosis that are sputum smear positive. We searched PubMed, MEDLINE, Embase, and Global Health databases for studies that included both children and adults with all forms of active TB. The pooled percentages of children and adults with smear positive TB were estimated using the inverse variance heterogeneity model. This review was registered in the PROSPERO database under registration number CRD42015015331. We identified 20 studies meeting our inclusion criteria that reported smear positivity for a total of 18,316 children and 162,574 adults from 14 countries. The pooled percentage of paediatric TB cases that were sputum smear positive was 6.8 % (95 % Confidence Interval (CI) 2.2–12.2 %), compared with 52.0 % (95 % CI 40.0–64.0 %) among adult cases. Eight studies reported data separately for children aged 0–4 and 5–14. The percentage of children aged 0–4 that were smear positive was 0.5 % (95 % CI 0.0–1.9 %), compared with 14.0 % (95 % CI 8.9–19.4 %) among children aged 5–14. Children, especially those aged 0–4, are much less likely to be sputum smear positive than adults. National TB programs relying on sputum smear for diagnosis are at risk of under-diagnosing and underestimating the burden of TB in children.Funding Information
- TB Alliance/WHO
- National Institutes of Health (K01AI102944)
- Swiss National Science Foundation (PBEZP3_140163)
This publication has 36 references indexed in Scilit:
- Childhood Tuberculosis in Household Contacts of Newly Diagnosed TB PatientsPLOS ONE, 2012
- Characteristics of adults and children diagnosed with tuberculosis in Lilongwe, Malawi: findings from an integrated HIV/TB clinicTropical Medicine & International Health, 2012
- The nuts and bolts of PROSPERO: an international prospective register of systematic reviewsSystematic Reviews, 2012
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Burden of New and Recurrent Tuberculosis in a Major South African City Stratified by Age and HIV-StatusPLOS ONE, 2011
- Characteristics of tuberculosis patients at intake in Cambodia, two provinces in China, and Viet NamBMC Public Health, 2011
- Evaluation of the Prognostic Value of IFN-γ Release Assay and Tuberculin Skin Test in Household Contacts of Infectious Tuberculosis Cases in SenegalPLOS ONE, 2010
- Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: a ten-year retrospective studyBMC Public Health, 2010
- Recent advances in the diagnosis of childhood tuberculosisArchives of Disease in Childhood, 2007
- Epidemiology of Tuberculosis in the Southeastern IranEuropean Journal of Epidemiology, 2005