title: Using a bus service for transporting sputum specimens to the Central Reference Laboratory: effect on the routine TB culture service in Malawi.
abstract: METHODS
  All non-private hospitals in Malawi that registered TB cases in 2001, during which there was a bus service for transporting sputum specimens to the Central Reference Laboratory (CRL) for mycobacterial culture and drug sensitivity testing (CDST).
  
  
  OBJECTIVE
  To determine the performance of the system of collecting and processing sputum specimens from patients with recurrent smear-positive pulmonary TB through to CDST.
  
  
  METHODS
  Structured interviews with TB Officers, and retrospective data collection using TB and laboratory registers.
  
  
  RESULTS
  There were 964 patients with recurrent smear-positive PTB. TB Officers took responsibility for collecting and transporting sputum to the CRL, and 73% reported using the bus service. Sputum specimens from 384 (40%) patients arrived at the CRL. Of these, 40% were found to have negative concentrated smears at the CRL, and 36% of specimen sets arriving at CRL were successfully cultured for DST. Most specimens had been collected after the start of anti-tuberculosis treatment. Although delays in collection adversely affected culture, only 43% of specimen sets collected on or before the first day of treatment yielded Mycobacterium tuberculosis.
  
  
  CONCLUSIONS
  Problems were identified at all stages of the system and strategies to remedy these are being put in place.
authors.affiliation: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi. adharries@malawi.net
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.forename: J
authors.initials: J
authors.lastname: Michongwe
authors.forename: T E
authors.initials: TE
authors.lastname: Nyirenda
authors.forename: J R
authors.initials: JR
authors.lastname: Kemp
authors.forename: S B
authors.initials: SB
authors.lastname: Squire
authors.forename: A R
authors.initials: AR
authors.lastname: Ramsay
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
authors.forename: F M
authors.initials: FM
authors.lastname: Salaniponi
mesh_terms: D018563:Disease Notification; D006801:Humans; D008295:Malawi; D008826:Microbial Sensitivity Tests; D018986:Motor Vehicles; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D013048:Specimen Handling / Q000379:methods*; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000382:microbiology*