Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?

Journal article

Timire, C, Sandy, C., Ngwenya, M., Woznitza, N., Kumar, A. M. V., Takarinda, K. C., Sengai, T. and Harries, A. D. 2019. Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable? Public Health Action. 9 (3), pp. 96-101. https://doi.org/10.5588/pha.19.0003
AuthorsTimire, C, Sandy, C., Ngwenya, M., Woznitza, N., Kumar, A. M. V., Takarinda, K. C., Sengai, T. and Harries, A. D.
Abstract

Setting: Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation.

Objectives: To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB.

Design: This was a cross-sectional study using programme data.

Results: A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64–78). Around 29% (95%CI 23–36) of the patients were potentially over-treated during Tas4TB.

Conclusion: Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.

Keywords CXR; SORT-IT; diagnostic accuracy; high-risk group; inter-observer variability
Year2019
JournalPublic Health Action
Journal citation9 (3), pp. 96-101
Publisherhttps://www.theunion.org/
ISSN2220-8372
Digital Object Identifier (DOI)https://doi.org/10.5588/pha.19.0003
Official URLhttps://doi.org/10.5588/pha.19.0003
Related URLhttps://www.ingentaconnect.com/journals/browse/iuatld/pha
Publication dates
Print01 Sep 2019
Publication process dates
Accepted12 Jun 2019
Deposited21 Nov 2019
Output statusPublished
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