title: Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India.
abstract: 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.
authors.affiliation: Tuberculosis Research Center, Chennai, Delhi, India.
authors.forename: T
authors.initials: T
authors.lastname: Santha
authors.forename: R
authors.initials: R
authors.lastname: Garg
authors.forename: R
authors.initials: R
authors.lastname: Subramani
authors.forename: V
authors.initials: V
authors.lastname: Chandrasekaran
authors.forename: N
authors.initials: N
authors.lastname: Selvakumar
authors.forename: R S
authors.initials: RS
authors.lastname: Sisodia
authors.forename: M
authors.initials: M
authors.lastname: Perumal
authors.forename: S K
authors.initials: SK
authors.lastname: Sinha
authors.forename: R J
authors.initials: RJ
authors.lastname: Singh
authors.forename: R
authors.initials: R
authors.lastname: Chavan
authors.forename: F
authors.initials: F
authors.lastname: Ali
authors.forename: S K
authors.initials: SK
authors.lastname: Sarma
authors.forename: K M
authors.initials: KM
authors.lastname: Sharma
authors.forename: R D
authors.initials: RD
authors.lastname: Jagtap
authors.forename: T R
authors.initials: TR
authors.lastname: Frieden
authors.forename: L
authors.initials: L
authors.lastname: Fabio
authors.forename: P R
authors.initials: PR
authors.lastname: Narayanan
mesh_terms: 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*