Date of Award

12-4-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Sarah Saleem

Department

Community Health Sciences

Abstract

Background: Pulmonary tuberculosis is still a major global health issue in low-income countries. Despite the global advances and development in diagnostic tools for TB, there’s yet a dearth of rapid, sensitive, and cost-effective diagnostic modalities in endemic and resource-limited settings. The high incidence of TB is usually due to diagnostic delays, either due to the prolonged reporting time of tests used or being missed out due to the low sensitivity of the diagnostic tests. It is important to validate and study the sensitivity and specificity of the simple screening tools to screen patients with clinical signs suggestive of tuberculosis.
Methodology: It was a multi-method study with a quantitative component for validating the screening tool for early detection of active pulmonary TB, against GeneXpert, as the gold standard. The study was conducted after formal approval by the ERC (2022-7900-22852). Patient’s medical record files who visited Aga Khan University Hospital ER and Internal Medicine and allied clinics between the 1st of January 2019 and December 31st, 2019. Data were extracted from patient’s medical record files who have information on clinical scoring and GeneXpert. The sensitivity, specificity, positive and negative predictive values, accuracy, and positive likelihood ratio between those who screened and tested positive were reported. For the qualitative component, after formal consent, 10 In-depth interviews were carried out, and results were evaluated on emerging themes and subthemes, through descriptive thematic analysis.
Results: Data were extracted from the medical records of 98 participants. The sensitivity of the screening tool was 84.9 % (95% CI - 72.4% - 93.3%), specificity was 31.1% (95% CI 18.2% - 46.7%), positive predictive value was 59.0% and negative predictive value was 64.0%, finally reported with an accuracy of 60.20%. The qualitative results yielded themes, related to early diagnosis of TB with ease, with the pros and cons of using the screening algorithm and providing recommendations for the development of a separate respiratory triage with a modified questionnaire, identifying the relevant gaps and barriers emphasizing tool revision through the addition of other explanatory questions, and the need for a separate respiratory triage.
Conclusion: We concluded that the screening tool had a high sensitivity and low specificity, emphasizing the need for revision of the questionnaire with clarity in the questions, and major themes on the early diagnosis of TB, with the pros and cons of using the screening algorithm and providing recommendations for the development of a separate respiratory triage with a modified questionnaire.

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Last Page

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