title: Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India.
abstract: BACKGROUND
  The present study measured the community prevalence and risk factors of adult pulmonary tuberculosis (PTB) in Chennai city, and also studied geographical distribution and the presence of different M. tuberculosis strains in the survey area.
  
  
  METHODS
  A community-based cross sectional survey was carried out from July 2010 to October 2012 in Chennai city. Prevalence of bacteriologically positive PTB was estimated by direct standardization method. Univariate and multivariate analyses were carried out to identify significant risk factors. Drug susceptibility testing and spoligotyping was performed on isolated M. tuberculosis strains. Mapping of PTB cases was done using geographic positioning systems.
  
  
  RESULTS
  Of 59,957 eligible people, 55,617 were screened by X-ray and /or TB symptoms and the prevalence of smear, culture, and bacteriologically positive PTB was estimated to be 228 (95% CI 189-265), 259 (95% CI 217-299) and 349 (95% CI 330-428) per 100,000 population, respectively. Prevalence of smear, culture, and bacteriologically positive PTB was highest amongst men aged 55-64 years. Multivariate analysis showed that occurrence of both culture and bacteriologically positive PTB disease was significantly associated with: age >35 years, past history of TB treatment, BMI <18.5 Kgs/m2, solid cooking fuel, and being a male currently consuming alcohol. The most frequent spoligotype family was East African Indian. Spatial distribution showed that a high proportion of patients were clustered in the densely populated north eastern part of the city.
  
  
  CONCLUSIONS
  Our findings demonstrate that TB is a major public health problem in this urban area of south India, and support the use of intensified case finding in high risk groups. Undernutrition, slum dwelling, indoor air pollution and alcohol intake are modifiable risk factors for TB disease.
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Baskaran
authors.initials: B
authors.lastname: Dhanaraj
authors.affiliation: India EIS Programme, National Centre for Disease Control, New Delhi, India.
authors.forename: Mohan Kumar
authors.initials: MK
authors.lastname: Papanna
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Srividya
authors.initials: S
authors.lastname: Adinarayanan
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Vedachalam
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Vijayaraj
authors.initials: V
authors.lastname: Sundaram
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Shivakumar
authors.initials: S
authors.lastname: Shanmugam
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Gomathi
authors.initials: G
authors.lastname: Sekar
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Pradeep Aravindan
authors.initials: PA
authors.lastname: Menon
authors.affiliation: Global TB Programme, World Health Organization, Geneva, Switzerland.
authors.forename: Fraser
authors.initials: F
authors.lastname: Wares
authors.affiliation: National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: Soumya
authors.initials: S
authors.lastname: Swaminathan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents