Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?
Timire, C;
Sandy, C;
Ngwenya, M;
Woznitza, N;
Kumar, AMV;
Takarinda, KC;
Sengai, T;
Harries, AD;
(2019)
Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?
PUBLIC HEALTH ACTION, 9 (3).
pp. 96-101.
ISSN 2220-8372
DOI: https://doi.org/10.5588/pha.19.0003
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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.