Diagnostic Performance of Xpert MTB/RIF Assay Versus Ziehl-Neelsen Method for the Diagnosis of Pulmonary Tuberculosis in Addis Ababa, Ethiopia

Boja Dufera Taddese1, *, Daniel Melese Desalegn1, Abay Sisay Misganaw2, Kumera Terfa Kitila1, Tinsae Kidanemariam Hailu1, Abraham Tesfaye Bika1
1 Addis Ababa Health Bureau, Public Health Research and Emergency Management, Addis Ababa, Ethiopia
2 Department of Medical Laboratory, College of Health Sciences, School of Allied Health sciences, Addis Ababa University, Addis Ababa, Ethiopia



Worldwide Tuberculosis (TB) is the ninth leading cause of death from a single infectious agent, positioning on top of Human Immuno Deficiency Virus (HIV) and it is still an eminently serious public health problem. In developing countries, Ziehl-Neelsen (ZN)-stained sputum smear microscopy is the most widely used diagnostic method in diagnosing Pulmonary Tuberculosis (PTB). This study was aimed to compare the diagnostic performances of ZN-method with Xpert MTB/RIF assay for the diagnosis of PTB in Addis Ababa, Ethiopia.


Facility-based cross-sectional study design was conducted from September 2016 to June 2017 on a total of 244 sputum samples collected from presumptive TB patients. The L-J sputum culture was used as a gold standard to compare the diagnostic performances of Xpert MTB/RIF assay and ZN-methods. Kappa values were analyzed by using statistical package for Social Science (SPSS) version 20 software at 95% Confidence Interval (CI). The Sensitivity, Specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of ZN-stained sputum smear microscopy and Xpert MTB/RIF assay were calculated against the gold standard.


The Sensitivity, Specificity, PPV and NPV of ZN-stained sputum smear microscopy were 68.38%, 95.28%, 93.02% and 76.58% respectively, while for Xpert MTB/ RIF assay were 88.89%, 81.89%, 81.89% and 88.89% respectively. The results of the two diagnostic approaches were concordant with the gold standard with a kappa value of ZN 0.650 and 0.743 for Xpert MTB/RIF assay.


This study concludes that the sensitivity of Xpert MTB/RIF assay was better than ZN-stained direct sputum smear microscopy for the diagnosis of pulmonary tuberculosis.

Keywords: Addis Ababa, Ethiopia, Xpert MTB/RIF assay, ZN, Pulmonary tuberculosis, Negative Predictive Value (NPV).

Abstract Information

Identifiers and Pagination:

Year: 2018
Volume: 12
Publisher Item Identifier: EA-TOMICROJ-2018-6

Article History:

Received Date: 31/7/2018
Revision Received Date: 19/10/2018
Acceptance Date: 22/10/2018
Electronic publication date: 30/10/2018
Collection year: 2018

© 2018 Taddese et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Correspondence: Address correspondence to this author at the Addis Ababa Health Bureau, Public Health Research and Emergency Management, Addis Ababa, Ethiopia; Tel: +251 91 138 2203; E-mail: duferataddese@yahoo.com