title: Non-tuberculous mycobacteria (NTM) in Zambia: prevalence, clinical, radiological and microbiological characteristics.
abstract: BACKGROUND
  Non-tuberculous mycobacteria (NTM) infection is an emerging health problem. We present here the Zambia-specific national level data of prevalence, symptomatic, radiological and microbiological characteristics of NTM, using results from a national Tuberculosis (TB) prevalence survey.
  
  
  METHODS
  This was a cross-sectional study of the prevalence of NTM among adults aged 15 years and above, who were participants in a national TB prevalence survey. Participants who had either an abnormal chest x-ray or were symptomatic were considered presumptive TB cases and submitted sputum for smear and culture analysis. HIV testing was performed on an opt-out basis. Symptomatic NTM prevalence was estimated from individual level analysis.
  
  
  RESULTS
  Of the 6,123 individuals with presumptive TB, 923 (15.1%) were found to have NTM, 13 (0.2%) were MTB/NTM co-infected and 338 (5.5%) were contaminated (indeterminate). The prevalence of symptomatic NTM was found to be 1,477/100,000 [95% CI 1010-1943]. Smear positivity, history of cough or chest pain and HIV positivity were risk factors for NTM.
  
  
  CONCLUSIONS
  This first study to estimate the national prevalence of NTM in Zambia indicates that the burden is high. The NTM occurrence in Zambia constitutes both a public health and ethical issue requiring action from health managers.
authors.affiliation: Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia. pascykapata@gmail.com.|Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands. pascykapata@gmail.com.
authors.forename: Pascalina
authors.initials: P
authors.lastname: Chanda-Kapata
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands. nkapata@gmail.com.|Department of Epidemics and Disease Control, Ministry of Community Development, Mother and Child Health, Lusaka, 10101, Zambia. nkapata@gmail.com.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, Netherlands. Eveline.klinkenberg@kncvtbc.org.|Department of Global Health and Development, Amsterdam Medical Centre, Amsterdam, Netherlands. Eveline.klinkenberg@kncvtbc.org.
authors.forename: Eveline
authors.initials: E
authors.lastname: Klinkenberg
authors.affiliation: Department of Clinical Care and Diagnostics, Chest Diseases Laboratory, Ministry of Health, Lusaka, 10101, Zambia. lnmulenga@gmail.com.
authors.forename: Lutinala
authors.initials: L
authors.lastname: Mulenga
authors.affiliation: Tuberculosis Laboratory, Tropical Diseases Research Centre, Ndola, Zambia. metembo2002@gmail.com.
authors.forename: Mathias
authors.initials: M
authors.lastname: Tembo
authors.affiliation: Tuberculosis Laboratory, University Teaching Hospital, Lusaka, 10101, Zambia. jejifpa@yahoo.com.
authors.forename: Patrick
authors.initials: P
authors.lastname: Katemangwe
authors.affiliation: Radiology Department, University Teaching Hospital, Lusaka, 10101, Zambia. verongwa@gmail.com.
authors.forename: Veronica
authors.initials: V
authors.lastname: Sunkutu
authors.affiliation: Department of Disease Surveillance, Control and Research, Ministry of Health, Lusaka, Zambia. pbmwaba2000@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.affiliation: Center of Tropical Medicine and Travel Medicine, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, Netherlands. m.p.grobusch@amc.uva.nl.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060085:Coinfection / Q000453:epidemiology; D003371:Cough / Q000150:complications / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification / Q000472:pathogenicity; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification / Q000472:pathogenicity*; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology