Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India.
METHODS
Governmental health facilities in six districts of India.


OBJECTIVE
To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > or =2 or > or =3 weeks.


METHODS
Trained health workers questioned each out-patient for presence of cough. Those with cough > or =2 weeks underwent sputum microscopy.


RESULTS
Of 55561 out-patients interviewed, 2210 (4%) had cough > or =2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > or =3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough > or =2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough > or =3 weeks.


CONCLUSIONS
The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough > or =3 weeks to > or =2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.
Santha
T
T
Tuberculosis Research Center, Chennai, Delhi, India.
Garg
R
R
Subramani
R
R
Chandrasekaran
V
V
Selvakumar
N
N
Sisodia
R S
RS
Perumal
M
M
Sinha
S K
SK
Singh
R J
RJ
Chavan
R
R
Ali
F
F
Sarma
S K
SK
Sharma
K M
KM
Jagtap
R D
RD
Frieden
T R
TR
Fabio
L
L
Narayanan
P R
PR
D000293:Adolescent; D000328:Adult; D000368:Aged; D003371:Cough / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006306:Health Surveys; D006801:Humans; D007194:India; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010045:Outpatients; D012680:Sensitivity and Specificity; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000175:diagnosis*