title: Hyperendemic pulmonary tuberculosis in peri-urban areas of Karachi, Pakistan.
abstract: BACKGROUND
  Currently there are very limited empirical data available on the prevalence of pulmonary tuberculosis among residents of marginalized settings in Pakistan. This study assessed the prevalence of pulmonary tuberculosis through active case detection and evaluated predictors of pulmonary tuberculosis among residents of two peri-urban neighbourhoods of Karachi, Pakistan.
  
  
  METHODS
  A cross-sectional study was conducted in two peri-urban neighbourhoods from May 2002 to November 2002. Systematic sampling design was used to select households for inclusion in the study. Consenting subjects aged 15 years or more from selected households were interviewed and, whenever possible, sputum samples were obtained. Sputum samples were subjected to direct microscopy by Ziehl-Neelson method, bacterial culture and antibiotic sensitivity tests.
  
  
  RESULTS
  The prevalence (per 100,000) of pulmonary tuberculosis among the subjects aged 15 years or more, who participated in the study was 329 (95% confidence interval (CI): 195-519). The prevalence (per 100,000) of pulmonary tuberculosis adjusted for non-sampling was 438 (95% CI: 282-651). Other than cough, none of the other clinical variables was significantly associated with pulmonary tuberculosis status. Analysis of drug sensitivity pattern of 15 strains of Mycobacterium tuberculosis revealed that one strain was resistant to isoniazid alone, one to streptomycin alone and one was resistant to isoniazid and streptomycin. The remaining 12 strains were susceptible to all five drugs including streptomycin, isoniazid, rifampicin, ethambutol, and pyrazinamide.
  
  
  CONCLUSIONS
  This study of previously undetected tuberculosis cases in an impoverished peri-urban setting reveals the poor operational performance of Pakistan's current approach to tuberculosis control; it also demonstrates a higher prevalence of pulmonary tuberculosis than current national estimates. Public health authorities may wish to augment health education efforts aimed at prompting health-seeking behaviour to facilitate more complete and earlier case detection. Such efforts to improve passive case-finding, if combined with more accessible DOTS infra-structure for treatment of detected cases, may help to diminish the high tuberculosis-related morbidity and mortality in marginalized populations. The economics of implementing a more active approach to case finding in resource-constrained setting also deserve further study.
authors.affiliation: Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait. saeed.akhtar@hsc.edu.kw
authors.forename: Saeed
authors.initials: S
authors.lastname: Akhtar
authors.forename: Franklin
authors.initials: F
authors.lastname: White
authors.forename: Rumina
authors.initials: R
authors.lastname: Hasan
authors.forename: Shafquat
authors.initials: S
authors.lastname: Rozi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Younus
authors.forename: Faiza
authors.initials: F
authors.lastname: Ahmed
authors.forename: Sara
authors.initials: S
authors.lastname: Husain
authors.forename: Bilquis Sana
authors.initials: BS
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology; D003140:Communicable Disease Control / Q000592:standards; D003430:Cross-Sectional Studies; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D010154:Pakistan / Q000453:epidemiology; D011204:Poverty Areas; D015995:Prevalence; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D014504:Urban Health / Q000706:statistics & numerical data*
chemical_list: D000995:Antitubercular Agents