Clinical diagnosis of smear-negative pulmonary tuberculosis: an audit of diagnostic practice in hospitals in Malawi.
METHODS
Thirty-seven hospitals in Malawi.


OBJECTIVE
To audit the hospital practice of clinically diagnosing adults with smear-negative pulmonary tuberculosis (PTB).


METHODS
A cross-sectional survey of adults aged 15 years or above who were registered and receiving inpatient treatment for smear-negative PTB. An assessment of each patient was carried out to determine 1) the number of recommended diagnostic guidelines (cough >3 weeks, no response to antibiotics, negative sputum smears and a chest radiograph compatible with PTB) used by hospital staff in making the diagnosis of PTB, and 2) whether the clinical diagnosis of smear-negative PTB was correct according to criteria set by the study.


RESULTS
There were 259 patients, 127 men and 132 women, with a mean age of 37 years; 93% had a cough >3 weeks, 95% had received one or more courses of antibiotics, 92% had submitted sputum samples for smear examination and 97% had chest radiographs performed. In 148 (57%) patients, all four diagnostic guidelines were used, and in 238 (92%) patients three or more were used. The diagnosis of smear-negative PTB was considered correct by study criteria in 203 (78%) patients. In the remainder, 22 (8%) were considered to have extrapulmonary TB and 34 (14%) another diagnosis.


CONCLUSIONS
Hospital practices in the diagnosis of smear-negative PTB are reasonable, although there is room for improvement with in-service training and regular audits of practice.
Harries
A D
AD
National Tuberculosis Control Programme, Ministry of Health, Lilongwe, Malawi. adharries@malawi.net
Hargreaves
N J
NJ
Kwanjana
J H
JH
Salaniponi
F M
FM
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006761:Hospitals; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D017410:Practice Guidelines as Topic; D012042:Registries; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology