title: Changes in pulmonary tuberculosis prevalence: evidence from the 2010 population survey in a populous province of China.
abstract: BACKGROUND
  This paper reports findings from the prevalence survey conducted in Shandong China in 2010, a province with a population of 94 million. This study aimed to estimate TB prevalence of the province in 2010 in comparison with the 2000 survey; and to compare yields of TB cases from different case finding approaches.
  
  
  METHODS
  A population based, cross-sectional survey was conducted using multi-stage random cluster sampling. 54,279 adults participated in the survey with a response rate of 96%. Doctors interviewed and classified participants as suspected TB cases if they presented with persistent cough, abnormal chest X-ray (CXRAY), or both. Three sputum specimens of all suspected cases were collected and sent for smear microscopy and culture.
  
  
  RESULTS
  Adjusted prevalence rate of bacteriologically confirmed cases was 34 per 100,000 for adults in Shandong in 2010. Compared to the 2000 survey, TB prevalence has declined by 80%. 53% of bacteriologically confirmed cases did not present persistent cough. The yield of bacteriologically confirmed cases was 47% by symptom screening and 95% by CXRAY. Over 50% of TB cases were among over 65's.
  
  
  CONCLUSIONS
  The prevalence rate of bacteriologically confirmed cases was significantly reduced compared with 2000. The survey raised challenges to identify TB cases without clear symptoms.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Wei
authors.affiliation: Center for Tuberculosis Control, Shandong Provincial Chest Hospital, 12 Lieshishan Dong Lu, Jinan 250101, China. zhangxiulei0531@126.com.
authors.forename: Xiulei
authors.initials: X
authors.lastname: Zhang
authors.forename: Jia
authors.initials: J
authors.lastname: Yin
authors.forename: John
authors.initials: J
authors.lastname: Walley
authors.forename: Rachel
authors.initials: R
authors.lastname: Beanland
authors.forename: Guanyang
authors.initials: G
authors.lastname: Zou
authors.forename: Hongmei
authors.initials: H
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Li
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Liu
authors.forename: Benny C Y
authors.initials: BC
authors.lastname: Zee
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003371:Cough; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D010820:Physicians; D015995:Prevalence; D013902:Radiography, Thoracic; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult