Comparison of Xpert MTB/RIF Ultra Results of Stool and Sputum in Children with Presumptive Tuberculosis in Southern Ethiopia

Authors: Yohannes Babo, Bihil Seremolo, Mamush Bogale, Ahmed Oumer, Yasin Wabe, Haba Churako, Alemu Bilat, Tamiru Degaga, Petra de Haas, Edine Tiemersma, Degu Jerene


The introduction of stool as a readily obtainable sample and the recently developed simple-one-step (SOS) stool processing method offer an opportunity for TB diagnosis in children. We conducted this study at secondary health facilities in Ethiopia which are the first level referral facilities for childhood TB diagnosis and treatment with the aim to determine if stool-based TB diagnosis can be performed with reasonable level of concordance with sputum tests in using Xpert MTB/RIF Ultra. Eligible children 0-14 years with presumptive pulmonary TB were asked to provide stools in addition to routinely requested sputum samples. We computed Cohen’s kappa statistic in SPSS to determine the level of agreement between stool and sputum test results. Of the 373 children included in the study, 61% were <5 years of age and 56% were male. Thirty-six children (9.7%) were diagnosed with TB and all started treatment. The rate of concordance between stool and sputum was high with kappa value of 0.83 (P<0.001). There were more Xpert ultra positive test results on stool (n=27 (7.2%)) than on sputum/NGA (n=23 (6.2%)). Laboratories in secondary hospitals can perform stool-based TB diagnosis in children with high concordance between stool and sputum test results reaffirming the applicability of the SOS method.

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