title: From suspect to patient: tuberculosis diagnosis and treatment initiation in health facilities in South Africa.
abstract: METHODS
  Thirteen primary health care (PHC) facilities in the Stellenbosch District, South Africa.
  
  
  OBJECTIVE
  To assess the use of a sputum register to evaluate the tuberculosis (TB) diagnostic process and the initiation of TB treatment in selected PHC facilities in a country with a centralised laboratory system.
  
  
  METHODS
  This prospective study was conducted between April 2004 and March 2005. The names of all individuals submitting sputum samples for TB testing were noted in a newly introduced sputum register. We classified all TB suspects with two positive smears as TB cases and consulted TB treatment registers until 3 months after sputum submission to determine how many had started treatment.
  
  
  RESULTS
  A total of 4062 persons aged > or =15 years submitted sputum samples, of whom 2484 were TB suspects. There were 2037 suspects with at least two results, 367 (18%) had at least two positive smears and 64 (17%) of these did not start treatment (initial defaulters). Over the entire diagnostic process, up to 5% of TB cases were missed, and up to 26% did not start treatment and were not reported.
  
  
  CONCLUSIONS
  By correcting diagnostic weaknesses identified in the sputum register, PHC facilities will be able to detect, treat and cure a higher percentage of TB patients.
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. ebotha@sun.ac.za
authors.forename: E
authors.initials: E
authors.lastname: Botha
authors.forename: S
authors.initials: S
authors.lastname: den Boon
authors.forename: K-A
authors.initials: KA
authors.lastname: Lawrence
authors.forename: H
authors.initials: H
authors.lastname: Reuter
authors.forename: S
authors.initials: S
authors.lastname: Verver
authors.forename: C J
authors.initials: CJ
authors.lastname: Lombard
authors.forename: C
authors.initials: C
authors.lastname: Dye
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.forename: N
authors.initials: N
authors.lastname: Beyers
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012042:Registries; D013019:South Africa; D013183:Sputum / Q000382:microbiology; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*