High prevalence of Tuberculosis and insufficient case detection in two communities in the Western Cape, South Africa

dc.contributor.authorClaassens, Mareli
dc.contributor.authorVan Schalkwyk, Cari
dc.contributor.authorDe Haan, Leonie
dc.contributor.authorFloyd, Sian
dc.contributor.authorDunbar, Rory
dc.contributor.authorVan Helden, Paul
dc.contributor.authorGodfrey-Faussett, Peter
dc.contributor.authorAyles, Helen
dc.contributor.authorBorgdorff, Martien
dc.contributor.authorEnarson, Donald
dc.contributor.authorBeyers, Nulda
dc.identifier.citationClaassens, M. et al. 2013. High prevalence of Tuberculosis and insufficient case detection in two communities in the Western Cape, South Africa. PloS ONE, 8(4): e58689, doi:10.1371/journal.pone.0058689.en_ZA
dc.identifier.issn1932-6203 (print)
dc.identifier.issn1932-6203 (online)
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.en_ZA
dc.descriptionThe original publication is available at
dc.description.abstractBackground: In South Africa the estimated incidence of all forms of tuberculosis (TB) for 2008 was 960/100000. It was reported that all South Africans lived in districts with Directly Observed Therapy, Short-course. However, the 2011 WHO report indicated South Africa as the only country in the world where the TB incidence is still rising. Aims: To report the results of a TB prevalence survey and to determine the speed of TB case detection in the study communities. Methods: In 2005 a TB prevalence survey was done to inform the sample size calculation for the ZAMSTAR (Zambia South Africa TB and AIDS Reduction) trial. It was a cluster survey with clustering by enumeration area; all households were visited within enumeration areas and informed consent obtained from eligible adults. A questionnaire was completed and a sputum sample collected from each adult. Samples were inoculated on both liquid mycobacterium growth indicator tube (MGIT) and Lo¨ wenstein-Jensen media. A follow-up HIV prevalence survey was done in 2007. Results: In Community A, the adjusted prevalence of culture positive TB was 32/1000 (95%CI 25–41/1000) and of smear positive TB 8/1000 (95%CI 5–13/1000). In Community B, the adjusted prevalence of culture positive TB was 24/1000 (95%CI17–32/1000) and of smear positive TB 9/1000 (95%CI 6–15/1000). In Community A the patient diagnostic rate was 0.38/person-year while in community B it was 0.30/person-year. In both communities the adjusted HIV prevalence was 25% (19–30%). Discussion: In both communities a higher TB prevalence than national estimates and a low patient diagnostic rate was calculated, suggesting that cases are not detected at a sufficient rate to interrupt transmission. These findings may contribute to the rising TB incidence in South Africa. The TB epidemic should therefore be addressed rapidly and effectively, especially in the presence of the concurrently high HIV prevalence.en_ZA
dc.description.sponsorshipStellenbosch Universityen_ZA
dc.format.extent8 p. : ill
dc.publisherPLoS ONEen_ZA
dc.subjectTuberculosis survey -- South Africaen_ZA
dc.subjectTuberculosis -- South Africa -- Researchen_ZA
dc.subjectTuberculosis -- Transmission -- South Africa -- Researchen_ZA
dc.subject.lcshTuberculosis -- Diagnosis -- South Africa -- Evaluationen_ZA
dc.subject.lcshTuberculosis -- Prevention -- South Africaen_ZA
dc.titleHigh prevalence of Tuberculosis and insufficient case detection in two communities in the Western Cape, South Africaen_ZA
dc.description.versionPublishers' versionen_ZA
dc.rights.holderAuthors retain copyrighten_ZA

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