title: The Prevalence of Tuberculosis in Zambia: Results from the First National TB Prevalence Survey, 2013-2014.
abstract: BACKGROUND
  Tuberculosis in Zambia is a major public health problem, however the country does not have reliable baseline data on the TB prevalence for impact measurement; therefore it was among the priority countries identified by the World Health Organization to conduct a national TB prevalence survey.
  
  
  OBJECTIVE
  To estimate the prevalence of tuberculosis among the adult Zambian population aged 15 years and above, in 2013-2014.
  
  
  METHODS
  A cross-sectional population-based survey was conducted in 66 clusters across all the 10 provinces of Zambia. Eligible participants aged 15 years and above were screened for TB symptoms, had a chest x-ray (CXR) performed and were offered an HIV test. Participants with TB symptoms and/or CXR abnormality underwent an in-depth interview and submitted one spot- and one morning sputum sample for smear microscopy and liquid culture. Digital data collection methods were used throughout the process.
  
  
  RESULTS
  Of the 98,458 individuals who were enumerated, 54,830 (55.7%) were eligible to participate, and 46,099 (84.1%) participated. Of those who participated, 45,633/46,099 (99%) were screened by both symptom assessment and chest x-ray, while 466/46,099 (1.01%) were screened by interview only. 6,708 (14.6%) were eligible to submit sputum and 6,154/6,708 (91.7%) of them submitted at least one specimen for examination. MTB cases identified were 265/6,123 (4.3%). The estimated national adult prevalence of smear, culture and bacteriologically confirmed TB was 319/100,000 (232-406/100,000); 568/100,000 (440-697/100,000); and 638/100,000 (502-774/100,000) population, respectively. The risk of having TB was five times higher in the HIV positive than HIV negative individuals. The TB prevalence for all forms was estimated to be 455 /100,000 population for all age groups.
  
  
  CONCLUSIONS
  The prevalence of tuberculosis in Zambia was higher than previously estimated. Innovative approaches are required to accelerate the control of TB.
authors.affiliation: National TB and Leprosy Control Program, Lusaka, Zambia.|Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kapata
authors.affiliation: Ministry of Health Headquarters, Lusaka, Zambia.|Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pascalina
authors.initials: P
authors.lastname: Chanda-Kapata
authors.affiliation: Ministry of Health Headquarters, Lusaka, Zambia.
authors.forename: William
authors.initials: W
authors.lastname: Ngosa
authors.affiliation: Ministry of Health Headquarters, Lusaka, Zambia.
authors.forename: Mine
authors.initials: M
authors.lastname: Metitiri
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, the Netherlands.|Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
authors.forename: Eveline
authors.initials: E
authors.lastname: Klinkenberg
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, the Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: Kalisvaart
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Veronica
authors.initials: V
authors.lastname: Sunkutu
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Aaron
authors.initials: A
authors.lastname: Shibemba
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Chishala
authors.initials: C
authors.lastname: Chabala
authors.affiliation: Department of Public Health, University of Zambia, Lusaka, Zambia.
authors.forename: Gershom
authors.initials: G
authors.lastname: Chongwe
authors.affiliation: Tropical Diseases Research Centre, Ndola, Zambia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Tembo
authors.affiliation: Chest Diseases Laboratory, Ministry of Health, Lusaka, Zambia.
authors.forename: Lutinala
authors.initials: L
authors.lastname: Mulenga
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Grace
authors.initials: G
authors.lastname: Mbulo
authors.affiliation: University Teaching Hospital, Lusaka, Zambia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Katemangwe
authors.affiliation: Ministry of Health Headquarters, Lusaka, Zambia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sakala
authors.affiliation: Ministry of Health Headquarters, Lusaka, Zambia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Chizema-Kawesha
authors.affiliation: Department of Economics, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.
authors.forename: Felix
authors.initials: F
authors.lastname: Masiye
authors.affiliation: United States Agency for International Development, Country Mission, Lusaka, Zambia.
authors.forename: George
authors.initials: G
authors.lastname: Sinyangwe
authors.affiliation: Global Tuberculosis Programme, World Health Organisation, Geneva, Switzerland.
authors.forename: Ikushi
authors.initials: I
authors.lastname: Onozaki
authors.affiliation: Ministry of Home Affairs headquarters, Lusaka, Zambia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaba
authors.affiliation: Ministry of Health Headquarters, Lusaka, Zambia.
authors.forename: Davy
authors.initials: D
authors.lastname: Chikamata
authors.affiliation: Division of Infection and Immunity, Department of Infection, University College London, London, United Kingdom.
authors.forename: Alimuddin
authors.initials: A
authors.lastname: Zumla
authors.affiliation: Centre for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Grobusch
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014376:Tuberculosis / Q000453:epidemiology*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology