title: [Problems of diagnosis of pulmonary tuberculosis. The case of the border region of Chiapas (Mexico)].
abstract: OBJECTIVE
  To analyze critical factors in the diagnosis of pulmonary tuberculosis at both the primary and secondary levels, in the Border Region of Chiapas, Mexico.
  
  
  METHODS
  A crossover study (from March to September, 1994)
  
  
  METHODS
  Patients with chronic cough (n = 221) who sought care in the Out-patient Department of the only second level care hospital available in the region for the uninsured population. Each subject was interviewed, three sputum specimens were requested and the clinical charts reviewed.
  
  
  RESULTS
  Fourty-four patients were found positive for pulmonary TB of which six came to the hospital for initial care. 38 had already been seen in a primary care setting. Of those 38 only two had been diagnosed previously by acid fast smear. At the hospital level, the underdiagnosis of TBP was 9%.
  
  
  CONCLUSIONS
  The quality of care with regard to the diagnosis of pulmonary tuberculosis needs to be improved at both the primary and hospital levels. Health workers need to be sensitized to the symptomatology and trained to request sputum smears when indicated. The general population also needs to be educated with regard to pulmonary tuberculosis so as to demand better services.
authors.affiliation: El Colegio de la Frontera del Sur, San Cristóbal de las Casas, Chiapas, México.
authors.forename: H J
authors.initials: HJ
authors.lastname: Sánchez-Pérez
authors.forename: D
authors.initials: D
authors.lastname: Halperin Frisch David
mesh_terms: D000293:Adolescent; D000328:Adult; D003371:Cough / Q000209:etiology; D018592:Cross-Over Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010045:Outpatients; D011320:Primary Health Care; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology