Case finding for pulmonary tuberculosis, Queen Elizabeth Central Hospital, Blantyre, Malawi.
METHODS
Queen Elizabeth Central Hospital, Malawi.


OBJECTIVE
To evaluate the investigation of patients with cough who attend out-patient services and the adherence to recommended diagnostic protocols.


METHODS
Two operational studies in 1995: 1) an audit of management of patients presenting to non-fee-paying out-patient services (OPD) with cough, and 2) an audit of the laboratory sputum register and the OPD cough register. The annual number of out-patient attendances was also recorded.


RESULTS
Of 2381 patients seen by OPD medical assistants, 438 (18.4%) complained of cough: 303 for < 3 weeks and 135 for > or = 3 weeks. Sputum smear examinations were requested in 97 patients, 79 (58.5%) with long duration and 18 (5.9%) with short duration of cough. Between May and December 1995, of the 1668 OPD patients who had sputum results in the laboratory register, 1392 (83%) had sputum results in the cough register. Of patients listed in the cough register, 98% collected their sputum smear results. In 1995, there were 395,439 OPD attendances; data extrapolation suggests that about 15,000 patients should have had sputum examined instead of the 2337 listed in the laboratory register.


CONCLUSIONS
A large burden is imposed on out-patient services by patients with cough. Despite recommended protocols, this investigation suggests deficiencies in case detection which require further study.
Harries
A D
AD
Department of Medicine, College of Medicine, Blantyre.
Kamenya
A
A
Schoevers
M A
MA
Boeree
M J
MJ
Nunn
P
P
Salaniponi
F M
FM
Nyangulu
D S
DS
D000328:Adult; D003371:Cough; D005260:Female; D006801:Humans; D008295:Malawi; D008297:Male; D010044:Outpatient Clinics, Hospital; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*