Tuberculosis in South and Central Africa Understanding epidemiology - Improving diagnosis and management

Tuberculosis (TB) is a globally leading infectious disease accounting for a particularly high burden of morbidity and mortality in sub-Saharan Africa. Knowledge of local TB epidemiology is a prerequisite for improving effective TB management but is often limited in settings with scarce resources and for vulnerable populations. Studying epidemiologic aspects of TB in Gabon we revealed a high rate of TB/HIV co-infection (42% in adults and 16% in children), limited access to first-line and second-line TB drugs entailing incorrect or unavailable TB treatment regimens, a low treatment success rate (53%) with a high mortality rate in TB/HIV co-infected patients (25%), and drug-resistant TB as major public health concern (31% multi-drug resistant TB in re-treatment TB cases). In South African children with suspected pulmonary TB (PTB) we found that focused point-of-care ultrasound for extra-pulmonary TB (EPTB) was a feasible diagnostic imaging tool that revealed a high prevalence of sonographic findings suggestive of concurrent EPTB in children with confirmed and unconfirmed PTB (31% and 30% versus 15% in children with unlikely TB) and contributed to effective monitoring of TB treatment response. We further found that in children administration of TB drugs differed substantially from recommended practice, potentially contributing to sub-therapeutic drug levels. In summary, the results presented in this thesis identified starting points for improving management of TB in Gabon and showed that point-of-care ultrasound can contribute to timely diagnosis of childhood TB and to monitoring TB treatment response.