Active Case Detection of Rifampicin Sensitive and Resistant Tuberculosis by Systematic Screening among Household Contacts of Rifampicin-Resistant Tuberculosis Patients in Dhaka, Bangladesh

Azizur Rahman Sharaque; K M Thouhidur  Rahman; Shahrin Emdad  Rayna; Marzan Sultana; Paul  Daru; Sayera  Banu; Syed Shariful  Islam; Md Khalequzzaman

doi:10.5937/scriptamed55-48548

Azizur Rahman Sharaque Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University
K M Thouhidur Rahman Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Shahrin Emdad Rayna Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Marzan Sultana Maternal and Child Health Department, National Institute of Preventive and Social medicine, Dhaka, Bangladesh
Paul Daru International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
Sayera Banu International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh
Syed Shariful Islam Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Md Khalequzzaman Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

DOI: https://doi.org/10.5937/scriptamed55-48548

Keywords: Tuberculosis, Bangladesh, Drug-resistant tuberculosis, Rifampicin, Close-contact transmission

Abstract

Background/Aim: Patients with rifampicin resistant-tuberculosis (RR-TB) may remain a source of infection for longer than patients with rifampicin sensitive-tuberculosis (RS-TB). This study aimed to detect active cases of RS-TB and RR-TB through systematic screening among household contacts of RR-TB patients in Dhaka, Bangladesh

Methods: This cross-sectional study was conducted among the 355 household contacts (HHCs) of 93 RR-TB primary cases identified from various centres in Dhaka, diagnosed between November 2020 and October 2021. For the identification of active cases of tuberculosis (TB), systematic screening among HHCs was done, where verbal screening was performed to check the presence of symptoms of TB. Those who had at least one symptoms of TB were considered as symptomatic contacts. Later GeneXpert analysis of sputum was done among the screened symptomatic contacts. Data was collected using a pretested, semi-structured, interviewer-administered questionnaire.

Results: An estimated 30.4% of respondents were ≤15 years of age. TB-like symptoms were prevalent among 9.9% of respondents. Loss of appetite (45.7%), unexplained weight loss (40.0%) and cough (37.1%) were the most common symptoms. Among the contacts with TB-like symptoms, 6.7% were diagnosed as a case of TB (3.35% were RR-TB, and 3.35% were RS-TB). The number needed to be screened to find an active case of TB was established at 178 among the HHCs of RR-TB.

Conclusions: About one in ten RR-TB HHCs showed TB-like symptoms. One in fifteen HHCs with TB-like symptoms was an active case of TB. Regular, effective screening of RR-TB contacts is needed to stop the transmission.

References

1. World Health Organization. Annual Report of Tuberculosis. Annu Glob TB Rep WHO [Internet]. 2022 [cited 2023 Feb 5];1–68. Available from: https://www.who.int/publications/i/item/9789240061729
2. Javaid A, Khan MA, Khan MA, Mehreen S, Basit A, Khan RA, et al. Screening outcomes of household contacts of multidrug-resistant tuberculosis patients in Peshawar, Pakistan. Asian Pac J Trop Med [Internet]. 2016 Sep 1 [cited 2022 Feb 8];9(9):909–12. Available from: https://pubmed.ncbi.nlm.nih.gov/27633308/
3. Mulder C, Klinkenberg E, Manissero D. Effectiveness of tuberculosis contact tracing among migrants and the foreign-born population. Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 2009.
4. USAID. Bangladesh tuberculosis roadmap overview, fiscal year 2021. Available from: https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/global-accelerator-end-tb/tb-roadmaps/bangladesh
5. National Tuberculosis Control Programme. National Guidelines and Operational Manual for Programmatic Management of Drug Resistant TB [Internet]. 2013 [cited 2023 Feb 11]. Available from: https://www.ntp.gov.bd/guidelines/
6. National Tuberculosis Control Programme. Tuberculosis Preventive Treatment Standard Operating Procedure. 2021. Available from: https://www.ntp.gov.bd/guidelines/
7. Reichler MR, Khan A, Yuan Y, Chen B, McAuley J, Mangura B, et al. Duration of Exposure Among Close Contacts of Patients With Infectious Tuberculosis and Risk of Latent Tuberculosis Infection. Clin Infect Dis [Internet]. 2020 Oct 10 [cited 2023 Mar 6];71(7):1627. Available from: /pmc/articles/PMC8851607/
8. World Health Organization. Optimizing active case-finding for tuberculosis Implementation lessons from South-East Asia [Internet]. 2021. 2021 [cited 2023 Mar 7]. 1–71 p. Available from: https://www.who.int/publications/i/item/9789290228486
9. Grimby G, Börjesson M, Jonsdottir IH, Schnohr P, Thelle DS, Saltin B. The “Saltin-Grimby Physical Activity Level Scale” and its application to health research. Scand J Med Sci Sports [Internet]. 2015 Dec 1 [cited 2022 Aug 8];25 Suppl 4:119–25. Available from: https://pubmed.ncbi.nlm.nih.gov/26589125/
10. Related Division and Health Promotion. About Adult BMI | Healthy Weight, Nutrition, and Physical Activity | CDC [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2021 Aug 20]. Available from: https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
11. Chatla C, Jaju J, Achanta S, Samyuktha R, Chakramahanti S, Purad C, et al. Active case finding of rifampicin sensitive and resistant TB among household contacts of drug resistant TB patients in Andhra Pradesh and Telangana states of India - A systematic screening intervention. Indian J Tuberc [Internet]. 2018 Jul 1 [cited 2022 Feb 8];65(3):218–24. Available from: https://pubmed.ncbi.nlm.nih.gov/29933863/
12. Kyaw NTT, Sithu A, Satyanarayana S, Kumar AMV, Thein S, Thi AM, et al. Outcomes of community-based systematic screening of household contacts of patients with multidrug-resistant tuberculosis in Myanmar. Trop Med Infect Dis [Internet]. 2020;5(1). Available from: www.mdpi.com/journal/tropicalmed
13. Qadeer E, Fatima R, Haq MU, Yaqoob A, Kyaw NTT, Shah S, et al. Yield of facility-based verbal screening amongst household contacts of patients with multi-drug resistant tuberculosis in Pakistan. J Clin Tuberc other Mycobact Dis [Internet]. 2017 May 1 [cited 2022 Feb 8];7:22–7. Available from: https://pubmed.ncbi.nlm.nih.gov/31723697/
14. Gupta A, Swindells S, Kim S, Hughes MD, Naini L, Wu X, et al. Feasibility of Identifying Household Contacts of Rifampin-and Multidrug-resistant Tuberculosis Cases at High Risk of Progression to Tuberculosis Disease. Clin Infect Dis [Internet]. 2020 Feb 1 [cited 2022 Feb 8];70(3):425–35. Available from: https://pubmed.ncbi.nlm.nih.gov/30942853/
15. Visca D, Ong CWM, Tiberi S, Centis R, D’Ambrosio L, Chen B, et al. Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects. Pulmonology [Internet]. 2021 Mar 1 [cited 2023 Feb 11];27(2):151–65. Available from: https://pubmed.ncbi.nlm.nih.gov/33547029/
16. Shadrach BJ, Kumar S, Deokar K, Singh GV, Hariharan, Goel R. A study of multidrug resistant tuberculosis among symptomatic household contacts of MDR-TB patients. Indian J Tuberc. 2021;
17. Hiruy N, Melese M, Habte D, Jerene D, Gashu Z, Alem G, et al. Comparison of the yield of tuberculosis among contacts of multidrug-resistant and drug-sensitive tuberculosis patients in Ethiopia using GeneXpert as a primary diagnostic test. Int J Infect Dis. 2018;