title: Population Based National Tuberculosis Prevalence Survey among Adults (>15 Years) in Pakistan, 2010-2011.
abstract: BACKGROUND
  We aimed to determine the prevalence of pulmonary tuberculosis (TB) amongst the adult population in 2010-2011 in Pakistan.
  
  
  METHODS
  A nationwide cross-sectional survey with multistage cluster sampling was conducted among adults (≥15 years) in 95 clusters in 2010-2011. All consenting participants were screened for cough and by chest X-ray. Participants with presumptive TB submitted two sputum samples for smear microscopy, culture, and molecular testing if needed. The TB prevalence estimates were adjusted for missing data and the cluster design.
  
  
  RESULTS
  Of 131,329 eligible individuals, 105,913 (81%) participated in the survey, of whom 10,471 (9.9%) were eligible for sputum examination. We found 341 bacteriologically positive TB cases of whom 233 had sputum smear-positive TB. The adjusted prevalence estimates for smear and bacteriologically positive TB were 270/100,000 (95% confidence interval (CI) 217-323), and 398/100,000 (95% CI 333-463), respectively. Only 61% of the diagnosed TB cases screened positive on symptoms (cough >2wks), whereas the other TB cases were detected based on X-ray abnormalities. The TB prevalence increased with age and was 1.8 times higher among men than women. The prevalence-to-notification ratio of smear-positive TB was 3.1 (95% CI 2.5-3.7), was higher among men than women, and increased with age.
  
  
  CONCLUSIONS
  Our data suggest that there is under-detection and/or -notification of TB, especially among men and elderly. TB control should be strengthened specifically in these risk groups. X-ray examination should be combined with symptom screening to enhance case detection.
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Ejaz
authors: E
authors: Qadeer
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Razia
authors: R
authors: Fatima
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Aashifa
authors: A
authors: Yaqoob
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Sabira
authors: S
authors: Tahseen
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Mahboob
authors: M
authors: Ul Haq
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Abdul
authors: A
authors: Ghafoor
authors: National Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors: Muhammad
authors: M
authors: Asif
authors: KNCV Tuberculosis Foundation, The Hague, The Netherlands.
authors: Masja
authors: M
authors: Straetemans
authors: KNCV Tuberculosis Foundation, The Hague, The Netherlands.
authors: Edine W
authors: EW
authors: Tiemersma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003371:Cough; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D011786:Quality Control; D013902:Radiography, Thoracic; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult