{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:07:33Z","timestamp":1788174453027,"version":"build-2803163510"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-025-17959-2","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T23:22:42Z","timestamp":1756768962000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Development and validation of a risk prediction model for pulmonary tuberculosis in presumptive tuberculosis patients in Tigray, northern Ethiopia"],"prefix":"10.1038","volume":"15","author":[{"given":"Gebremedhin Berhe","family":"Gebregergs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gebretsadik","family":"Berhe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kibrom Gebreslasie","family":"Gebrehiwot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afework","family":"Mulugeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"17959_CR1","unstructured":"WHO. Global Tuberculosis Report 2024 (World Health Organization, 2024)."},{"key":"17959_CR2","unstructured":"PIN. TB Is the Deadliest Infectious Disease. So why Haven\u2019t You Heard of It? (Partners In Health, 2024)."},{"key":"17959_CR3","doi-asserted-by":"publisher","first-page":"146","DOI":"10.11604\/pamj.2022.43.146.35557","volume":"43","author":"TB Agizew","year":"2022","unstructured":"Agizew, T. B. et al. Prospects for tuberculosis elimination in ethiopia: feasibility, challenges, and opportunities. Pan Afr. Med. J. 43, 146. https:\/\/doi.org\/10.11604\/pamj.2022.43.146.35557 (2022).","journal-title":"Pan Afr. Med. J."},{"key":"17959_CR4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13031-024-00583-8","volume":"18","author":"KG Gebrehiwot","year":"2024","unstructured":"Gebrehiwot, K. G. et al. War-related disruption of clinical tuberculosis services in tigray, Ethiopia during the recent regional conflict: a mixed sequential method study. BMC Confl. Health. 18, 29 (2024).","journal-title":"BMC Confl. Health"},{"key":"17959_CR5","unstructured":"IHME. VizHub - GBD Results from 1990 to 2019., https:\/\/vizhub.healthdata.org\/gbd-results\/ (2023)."},{"key":"17959_CR6","doi-asserted-by":"publisher","first-page":"3241","DOI":"10.2147\/idr.s464787","volume":"17","author":"GB Gebregergs","year":"2024","unstructured":"Gebregergs, G. B., Berhe, G., Gebrehiwot, K. G. & Mulugeta, A. Predicting tuberculosis incidence and its trend in tigray, ethiopia: A Reality-Counterfactual modeling approach. Infect. Drug Resist. 17, 3241\u20133251. https:\/\/doi.org\/10.2147\/idr.s464787 (2024).","journal-title":"Infect. Drug Resist."},{"key":"17959_CR7","unstructured":"WHO. The End TB Strategy (World Health Organization, 2014)."},{"key":"17959_CR8","unstructured":"WHO. Primary Health Care Systems (PRIMASYS): Case Study from Ethiopia, Abridged Version (World Health Organization, 2017)."},{"key":"17959_CR9","doi-asserted-by":"publisher","first-page":"e007328","DOI":"10.1136\/bmjgh-2021-007328","volume":"6","author":"H Gesesew","year":"2021","unstructured":"Gesesew, H. et al. The impact of war on the health system of the Tigray region in ethiopia: an assessment. BMJ Global Health. 6, e007328 (2021).","journal-title":"BMJ Global Health"},{"key":"17959_CR10","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12962-024-00544-1","volume":"22","author":"LF Assebe","year":"2024","unstructured":"Assebe, L. F. et al. Cost-effectiveness of TB diagnostic technologies in ethiopia: a modelling study. Cost-effectiveness Resource Allocation: C\/E. 22, 43. https:\/\/doi.org\/10.1186\/s12962-024-00544-1 (2024).","journal-title":"Cost-effectiveness Resource Allocation: C\/E"},{"key":"17959_CR11","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1177\/004947559302300402","volume":"23","author":"CM Parry","year":"1993","unstructured":"Parry, C. M. Sputum smear negative pulmonary tuberculosis. Trop. Doct. 23, 145\u2013146. https:\/\/doi.org\/10.1177\/004947559302300402 (1993).","journal-title":"Trop. Doct."},{"key":"17959_CR12","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1186\/s12879-017-2759-0","volume":"17","author":"D Shaweno","year":"2017","unstructured":"Shaweno, D., Trauer, J. M., Denholm, J. T. & McBryde, E. S. A novel bayesian Geospatial method for estimating tuberculosis incidence reveals many missed TB cases in Ethiopia. BMC Infect. Dis. 17, 662. https:\/\/doi.org\/10.1186\/s12879-017-2759-0 (2017).","journal-title":"BMC Infect. Dis."},{"key":"17959_CR13","unstructured":"People\u2019s Health Movement. Health Workers, Tigray."},{"key":"17959_CR14","doi-asserted-by":"crossref","unstructured":"Legesse, A. Y. et al. Lived experience of healthcare providers amidst war and siege: a phenomenological study of ayder comprehensive specialized hospital of tigray, Northern Ethiopia. BMC Health Serv. Res. 292 (2024).","DOI":"10.1186\/s12913-024-10655-3"},{"key":"17959_CR15","unstructured":"UNICEF. Ethiopia Humanitarian Situation: Tigray Crisis Situation Report No.2. United Nations International Children\u2019s Emergency Fund (UNICEF). https:\/\/www.unicef.org\/media\/92186\/file\/UNICEF-Ethiopia-Humanitarian-Situation-Report-No.-2-Tigray-Crisis-14-31-January-2021.pdf (2021)."},{"key":"17959_CR16","doi-asserted-by":"publisher","first-page":"d8312","DOI":"10.1136\/bmj.d8312","volume":"344","author":"ST Adams","year":"2012","unstructured":"Adams, S. T. & Leveson, S. H. Clinical prediction rules. BMJ (Clinical Res. ed.). 344, d8312. https:\/\/doi.org\/10.1136\/bmj.d8312 (2012).","journal-title":"BMJ (Clinical Res. ed.)"},{"key":"17959_CR17","unstructured":"WHO. Mid-level Health Providers a Promising Resource To Achieve the Health Millennium Development Goals: Global Health Workforce Alliance, Report (World Health Organization, 2010). https:\/\/www.who.int\/workforcealliance\/knowledge\/resources\/Final_MLP_web_2.pdf"},{"key":"17959_CR18","doi-asserted-by":"crossref","unstructured":"Gebregergs, G. B., Berhe, G., Gebrehiwot, K. G. & Mulugeta, A. A qualitative study to inform the development of a decision support tool for the diagnosis of pulmonary tuberculosis in Tigray, Ethiopia. BMC Med. Informat. Dec.  Making 24:338,   (2024).","DOI":"10.1186\/s12911-024-02765-z"},{"key":"17959_CR19","doi-asserted-by":"publisher","first-page":"ofu095","DOI":"10.1093\/ofid\/ofu095","volume":"1","author":"TT Balcha","year":"2014","unstructured":"Balcha, T. T. et al. A clinical scoring algorithm for determination of the of tuberculosis in HIV-Infected adults: A cohort study performed at Ethiopian health centers. Open. Forum Infect. Dis. 1, ofu095. https:\/\/doi.org\/10.1093\/ofid\/ofu095 (2014).","journal-title":"Open. Forum Infect. Dis."},{"key":"17959_CR20","doi-asserted-by":"publisher","first-page":"e076587","DOI":"10.1136\/bmjopen-2023-076587","volume":"13","author":"HF Wolde","year":"2023","unstructured":"Wolde, H. F., Clements, A. C. A. & Alene, K. A. Development and validation of a risk prediction model for pulmonary tuberculosis among presumptive tuberculosis cases in Ethiopia. BMJ Open. 13, e076587. https:\/\/doi.org\/10.1136\/bmjopen-2023-076587 (2023).","journal-title":"BMJ Open."},{"key":"17959_CR21","unstructured":"Akamo, J. O. & Fisseha, T. The EU\u2019s Entry Point into the Post-Tigray War Context. (2023)."},{"key":"17959_CR22","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1002\/sim.7992","volume":"38","author":"RD Riley","year":"2018","unstructured":"Riley, R. D. et al. Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes. Stat. Med. 38, 1276\u20131296. https:\/\/doi.org\/10.1002\/sim.7992 (2018).","journal-title":"Stat. Med."},{"key":"17959_CR23","doi-asserted-by":"publisher","unstructured":"Steingart, K. R. et al. Xpert\u00ae MTB\/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. The Cochrane database of systematic reviews 2014, Cd009593, https:\/\/doi.org\/10.1002\/14651858.CD009593.pub3 (2014).","DOI":"10.1002\/14651858.CD009593.pub3"},{"key":"17959_CR24","doi-asserted-by":"publisher","first-page":"205031212412432","DOI":"10.1177\/20503121241243238","volume":"12","author":"GB Gebregergs","year":"2024","unstructured":"Gebregergs, G. B., Berhe, G., Gebrehiwot, K. G. & Mulugeta, A. Predictors contributing to the Estimation of pulmonary tuberculosis among adults in a resource-limited setting: A systematic review of diagnostic predictions. SAGE Open. Med. 12, 20503121241243238. https:\/\/doi.org\/10.1177\/20503121241243238 (2024).","journal-title":"SAGE Open. Med."},{"key":"17959_CR25","unstructured":"Fonti, V. & Belitser, E. Feature Selection using LASSOVU Amsterdam, Research Paper in Business Analytics,. (2017)."},{"key":"17959_CR26","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1016\/S0895-4356(03)00047-7","volume":"56","author":"E Steyerberg","year":"2003","unstructured":"Steyerberg, E., Bleeker, S., Moll, H. A., Grobbee, D. & Moons, K. Internal and external validation of predictive models: a simulation study of bias and precision in small samples. J. Clin. Epidemiol. 56, 441\u2013447 (2003).","journal-title":"J. Clin. Epidemiol."},{"key":"17959_CR27","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/0272989X06295361","volume":"26","author":"AJ Vickers","year":"2006","unstructured":"Vickers, A. J. & Elkin, E. B. Decision curve analysis: a novel method for evaluating prediction models. Med. Decis. Making. 26, 565\u2013574 (2006).","journal-title":"Med. Decis. Making"},{"key":"17959_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-014-0241-z","volume":"13","author":"GS Collins","year":"2015","unstructured":"Collins, G. S., Reitsma, J. B., Altman, D. G. & Moons, K. G. M. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMC Med. 13, 1. https:\/\/doi.org\/10.1186\/s12916-014-0241-z (2015).","journal-title":"BMC Med."},{"key":"17959_CR29","unstructured":"Fletcher, R. H., Fletcher, S. W. & Fletcher, G. S. Clinical Epidemiology, the Essentials (Lippincott Williams & Wilkins, 2014)."},{"key":"17959_CR30","doi-asserted-by":"publisher","first-page":"8727","DOI":"10.1038\/s41598-018-27024-w","volume":"8","author":"M Zhu","year":"2018","unstructured":"Zhu, M. et al. Times series analysis of age-specific tuberculosis at a rapid developing region in china, 2011\u20132016. Sci. Rep. 8, 8727. https:\/\/doi.org\/10.1038\/s41598-018-27024-w (2018).","journal-title":"Sci. Rep."},{"key":"17959_CR31","unstructured":"WHO. WHO Releases New Global Lists of high-burden Countries for TB, HIV-associated TB, and drug-resistant TB (World Health Organization, 2021)."},{"key":"17959_CR32","doi-asserted-by":"publisher","first-page":"e429","DOI":"10.1016\/s2352-3018(21)00069-2","volume":"8","author":"KA Risher","year":"2021","unstructured":"Risher, K. A. et al. Age patterns of HIV incidence in Eastern and Southern africa: a modelling analysis of observational population-based cohort studies. Lancet HIV. 8, e429\u2013e439. https:\/\/doi.org\/10.1016\/s2352-3018(21)00069-2 (2021).","journal-title":"Lancet HIV"},{"key":"17959_CR33","doi-asserted-by":"publisher","unstructured":"Lyon, S. M. & Rossman, M. D. Pulmonary tuberculosis. Microbiol. Spectr. 5 https:\/\/doi.org\/10.1128\/microbiolspec (2017).","DOI":"10.1128\/microbiolspec"},{"key":"17959_CR34","doi-asserted-by":"publisher","first-page":"e1003420","DOI":"10.1371\/journal.pmed.1003420","volume":"17","author":"Y Baik","year":"2020","unstructured":"Baik, Y. et al. A clinical score for identifying active tuberculosis while awaiting Microbiological results: development and validation of a multivariable prediction model in sub-Saharan Africa. PLoS Med. 17, e1003420. https:\/\/doi.org\/10.1371\/journal.pmed.1003420 (2020).","journal-title":"PLoS Med."},{"key":"17959_CR35","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/s2213-2600(18)30105-x","volume":"6","author":"H Esmail","year":"2018","unstructured":"Esmail, H., Dodd, P. J. & Houben, R. Tuberculosis transmission during the subclinical period: could unrelated cough play a part? Lancet Respiratory Med. 6, 244\u2013246. https:\/\/doi.org\/10.1016\/s2213-2600(18)30105-x (2018).","journal-title":"Lancet Respiratory Med."},{"key":"17959_CR36","doi-asserted-by":"publisher","first-page":"4379","DOI":"10.21037\/jtd.2019.09.62","volume":"11","author":"Z Wang","year":"2019","unstructured":"Wang, Z., Wang, M., Wen, S., Yu, L. & Xu, X. Types and applications of cough-related questionnaires. J. Thorac. Disease. 11, 4379\u20134388. https:\/\/doi.org\/10.21037\/jtd.2019.09.62 (2019).","journal-title":"J. Thorac. Disease"},{"key":"17959_CR37","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1038\/s43856-022-00149-w","volume":"2","author":"AJ Zimmer","year":"2022","unstructured":"Zimmer, A. J. et al. Making cough count in tuberculosis care. Commun. Med. 2, 83. https:\/\/doi.org\/10.1038\/s43856-022-00149-w (2022).","journal-title":"Commun. Med."},{"key":"17959_CR38","doi-asserted-by":"publisher","first-page":"e0269219","DOI":"10.1371\/journal.pone.0269219","volume":"17","author":"K Kaswaswa","year":"2022","unstructured":"Kaswaswa, K. et al. Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi. PLoS One. 17, e0269219 (2022).","journal-title":"PLoS One"},{"key":"17959_CR39","doi-asserted-by":"publisher","first-page":"ofz543","DOI":"10.1093\/ofid\/ofz543","volume":"7","author":"TH Boyles","year":"2020","unstructured":"Boyles, T. H. et al. A clinical prediction score including trial of antibiotics and C-Reactive protein to improve the diagnosis of tuberculosis in ambulatory people with HIV. Open. Forum Infect. Dis. 7, ofz543. https:\/\/doi.org\/10.1093\/ofid\/ofz543 (2020).","journal-title":"Open. Forum Infect. Dis."},{"key":"17959_CR40","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1016\/s1473-3099(20)30143-2","volume":"20","author":"TH Divala","year":"2020","unstructured":"Divala, T. H. et al. Utility of broad-spectrum antibiotics for diagnosing pulmonary tuberculosis in adults: a systematic review and meta-analysis. Lancet Infect. Dis. 20, 1089\u20131098. https:\/\/doi.org\/10.1016\/s1473-3099(20)30143-2 (2020).","journal-title":"Lancet Infect. Dis."},{"key":"17959_CR41","unstructured":"Long, R. & Cowie, R. Tuberculosis: 4. Pulmonary disease. CMAJ 160, 1344\u20131348 (1999)."},{"key":"17959_CR42","doi-asserted-by":"publisher","first-page":"e0235411","DOI":"10.1371\/journal.pone.0235411","volume":"15","author":"K Tedla","year":"2020","unstructured":"Tedla, K., Medhin, G., Berhe, G., Mulugeta, A. & Berhe, N. Factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in tigray, Northern Ethiopia. PLoS One. 15, e0235411. https:\/\/doi.org\/10.1371\/journal.pone.0235411 (2020).","journal-title":"PLoS One"},{"key":"17959_CR43","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1186\/s12879-021-06552-3","volume":"21","author":"J Ouyang","year":"2021","unstructured":"Ouyang, J. et al. The development and validation of a diagnostic scoring system to differentiate pulmonary tuberculosis from non-tuberculosis pulmonary infections in HIV-infected patients with severe immune suppression. BMC Infect. Dis. 21, 863. https:\/\/doi.org\/10.1186\/s12879-021-06552-3 (2021).","journal-title":"BMC Infect. Dis."},{"key":"17959_CR44","doi-asserted-by":"publisher","first-page":"5755","DOI":"10.2147\/idr.s410923","volume":"16","author":"Q Yu","year":"2023","unstructured":"Yu, Q., Guo, J. & Gong, F. Construction and validation of a diagnostic scoring system for predicting active pulmonary tuberculosis in patients with positive T-SPOT based on indicators associated with coagulation and inflammation: A retrospective Cross-Sectional study. Infect. Drug Resist. 16, 5755\u20135764. https:\/\/doi.org\/10.2147\/idr.s410923 (2023).","journal-title":"Infect. Drug Resist."},{"key":"17959_CR45","unstructured":"WHO. High-priority Target Product Profiles for New Tuberculosis Diagnostics: Report of a Consensus Meeting (World Health Organization, 2014)."},{"key":"17959_CR46","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1038\/nrmicro2521","volume":"9","author":"R McNerney","year":"2011","unstructured":"McNerney, R. & Daley, P. Towards a point-of-care test for active tuberculosis: Obstacles and opportunities. Nat. Rev. Microbiol. 9, 204\u2013213. https:\/\/doi.org\/10.1038\/nrmicro2521 (2011).","journal-title":"Nat. Rev. Microbiol."},{"key":"17959_CR47","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1590\/S0034-89102011005000071","volume":"45","author":"CBA Castro","year":"2011","unstructured":"Castro, C. B. A., Costa, P. A., Ruffino-Netto, A., Maciel, E. L. N. & Kritski, A. L. Assessment of a clinical score for screening suspected pulmonary tuberculosis cases. Rev. Sa\u00fade P\u00fablica. 45, 1110\u20131116 (2011).","journal-title":"Rev. Sa\u00fade P\u00fablica"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17959-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17959-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17959-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T02:41:54Z","timestamp":1757472114000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-17959-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["17959"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-17959-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]},"assertion":[{"value":"14 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"32270"}}