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The 3rd National TB Prevalence Survey Non-Bangkok clusters in Thailand
in 2012 Preliminary Results
29th April 2013
Chawetsan Namwat, MD, Director of TB Bureau
Sriprapa Nateniyom, MD, Senior medical doctor in preventive medicine
Sirinapha Jittimanee, PhD, Public Health Officer
Department of Disease Control, Ministry of Public Health
2 |
Background
Indicator (2011) Population size 70 million GNI per capita (Atlas method) 4,400 ($US)
Estimated TB Burden (2011)
Number Rate
Cases (all forms) 76,000 N/A Mortality 9,800 14 per 100,000 TB cases with HIV 15 % N/A Case notifications 67,676 97 per 100,000 Treatment success 41,451 61 %
4 |
90,000 Target
100 clusters 900 people
Sampling design Sample size: 76,331 Number of clusters: 100 Sampling method:
Stratified multi-stage cluster sampling, stratified by area (Bangkok, urban outside Bangkok, rural outside Bangkok)
5 |
Selection criteria and health seeking behaviour
Inclusion criteria Aged 15 years or more
Slept in the clusters 14 days or more
Screening Positive Clinical score > 3
Abnormal CXR
Health seeking behavior Each cluster, 3 participants with screening positive were interviewed their health seeking behavior.
6 |
Laboratory methods Smear:
Direct smear Ziehl-Neelsen staining Two samples (one spot and one early morning)
Culture media: Modified (2%) Ogawa method Two samples (one spot and one early morning)
Other: One lab for preparation for reagent staining and media for culture
and 12 DDC lab for smear and culture and identification No GeneXpert MTB/RIF No Drug sensitivity testing of positive samples No HIV testing of participants or survey patients
8 |
Main challenges of survey implementation
Low participation rates in urban clusters due to annual CXR check-up for employment, not staying at home during census, middle to high income communities.
There were 12 survey teams and each one had limited experience on the first-second clusters. However, the team members were familiar with communities.
Most of budget was from the GF which requested a lot of supporting documents for payment, i.e Non-registered migrants declined due to lack of the ID numbers/ work permits.
10 |
CXR+ and/or Symptom+ = 6,032 (9.8%)
Smear Neg = 5,926
Smear Pos =75
CMTB=
84
CON 196
NTM 20
C Neg 5,626
Definite = 130
C Neg=23
CMTB =
46
No TB
13
TB consistent 10
CON = 1
NTM=5
TB consistent
1
TB consistent 1 (on TB Tx)
No TB 4
Probable = 12
CXR CXR
NA = 31 (missing sputum sample 1 & 2)
Eligible = 78,647
Participants = 61,653 (78%)
Non-Participants = 17,098 (22%)
Screening neg. 55,552 (90%)
Preliminary results of 83 Non-Bangkok
clusters in 2012
11 |
Participants
•78,680 Total census
•78,647 (99.96%) Eligible to participate
•61,653 (78.39%) Participants
12 |
Eligibility by age group and sex
99.84 99.91 99.93
100.00 99.97 99.96 99.96 99.95 99.98 99.97 99.99 100.00
99.00
99.20
99.40
99.60
99.80
100.00
100.20
100.40
15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+
Perc
enta
ge e
ligib
le (%
)
Age group (years)
Eligibility by age group and gender
MaleFemale
13 |
Participation by age group and sex
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
15 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65+
Part
icip
atio
n ra
te
Age Group (Years)
Participation by age group and sex
Male
Female
Overall participation rate: 78.4%
14 |
Participation by cluster
0
10
20
30
40
50
60
70
80
90
100
9 77 46 10 25 11 47 19 12 35 5 36 13 33 6 34 14 37 7 38 20 63 1 54 15 55 2 31 8 53 22 56 3 57 40 4 67 68 44 69 60 62
Part
icip
atio
n ra
te (%
)
Cluster number
Participation rate by cluster (chronological order)
15 |
0
10
20
30
40
50
60
70
80
90
100
9 18 11 80 5 50 83 30 1 56 66 3 44 72 60
Part
icip
atio
n ra
te (%
)
Cluster number
Participation rate by URBAN clusters (chronological order)
16 |
0
10
20
30
40
50
60
70
80
90
100
45 17 78 25 24 19 12 35 27 81 49 82 34 14 37 38 20 63 52 64 29 59 21 58 16 65 32 57 40 4 67 68 69 61
Part
icip
atio
n ra
te (%
)
Cluster number
Participation rate by URBAN clusters (chronological order)
17 |
Screening and laboratory investigations
• 61,653 Total screened
• NA Symptom positive
• 5,963 (9.7%) CXR positive
• NA Both symptom and CXR positive
• 6,032 (9.8%) Screened positive
• 5,993 (spot) 5,741 (morning) Total specimens obtained
• 6,001 Number of participants with lab results
Spot Morning missing = 39 Missing =
291
18 |
Results of TB Prevalence: Age ≥15 years*
Smear Positive MTB case (n=58):
Bacteriologically Confirmed MTB (n=142):
19 |
Confirmed MTB survey cases: Symptoms and CXR screening results
Screening method Smear positive MTB
survey cases, n=58 Bacteriologically confirmed MTB
survey cases, n=142 Total number of
survey cases Percentage of all
survey cases Total number of
survey cases Percentage of all
survey cases
Symptom positive only 1 2% 5 4% CXR positive only 30 52% 95 67% Symptom and CXR positive 27 47% 42 30% What proportion of MTB survey cases were smear negative? => 84/142 = 59% What proportion of MTB survey cases were detected by CXR? => 95/142 = 67% What proportion of MTB survey cases were detected by symptoms? => 5/142 = 4% What proportion of MTB survey cases would have been detected by the current screening strategy in your country? => 42/142 = 30%
20 |
Laboratory results • 5,993 (spot) 5,741 (morning) Total specimens
obtained
•78 cases , 116 samples Any smear positive
•133 cases, 181 samples Any culture MTB
•46 cases, 75 samples S+C+
•84 cases, 106 samples S-C+
21 |
Study cases Smear positive
MTB cases
Bacteriologically confirmed MTB cases
Total number of study cases 58
142
Definite case 46
130
Probable case 12
12
Possible case- No study case (SM+ without other evidence/ or scanty C-MTB+ without other evidence)
(13) (0)
Non-study cases (NTM) (4)
(24)
Number of subjects that are smear positive
75 -
Definite cases: Culture positive with AFB+ or abnormal CXR Probable cases: SM+ and CXR abnormal and culture no growth Possible cases: SM+ (scanty) with symptom, CXR normal, Culture not MTB positive inc. MOTT/NTM Non-study cases: SM+, NTM,
23 |
Prevalence survey – provisional result, Thai- non-Bangkok (/100 000 participants aged 15y or older)
PENDING
25 |
Next steps Data entry and data analysis for non-BKK clusters (n=83) Data collection for BKK clusters (n=17) Report writing