Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?
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.
|Authors||Timire, C, Sandy, C., Ngwenya, M., Woznitza, N., Kumar, A. M. V., Takarinda, K. C., Sengai, T. and Harries, A. D.|
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|
|Journal||Public Health Action|
|Journal citation||9 (3), pp. 96-101|
|Digital Object Identifier (DOI)||doi:10.5588/pha.19.0003|
|01 Sep 2019|
|Publication process dates|
|Accepted||12 Jun 2019|
|Deposited||21 Nov 2019|
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