title: Sputum, sex and scanty smears: new case definition may reduce sex disparities in smear-positive tuberculosis.
abstract: METHODS
  Urban clinic, Nairobi.
  
  
  OBJECTIVE
  To evaluate the impact of specimen quality and different smear-positive tuberculosis (TB) case (SPC) definitions on SPC detection by sex.
  
  
  METHODS
  Prospective study among TB suspects.
  
  
  RESULTS
  A total of 695 patients were recruited: 644 produced > or =1 specimen for microscopy. The male/female sex ratio was 0.8. There were no significant differences in numbers of men and women submitting three specimens (274/314 vs. 339/380, P = 0.43). Significantly more men than women produced a set of three 'good' quality specimens (175/274 vs. 182/339, P = 0.01). Lowering thresholds for definitions to include scanty smears resulted in increases in SPC detection in both sexes; the increase was significantly higher for women. The revised World Health Organization (WHO) case definition was associated with the highest detection rates in women. When analysis was restricted only to patients submitting 'good' quality specimen sets, the difference in detection between sexes was on the threshold for significance (P = 0.05).
  
  
  CONCLUSIONS
  Higher SPC notification rates in men are commonly reported by TB control programmes. The revised WHO SPC definition may reduce sex disparities in notification. This should be considered when evaluating other interventions aimed at reducing these. Further study is required on the effects of the human immuno-deficiency virus and instructed specimen collection on sex-specific impact of new SPC definition.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK. ramsaya@who.int
authors.forename: A
authors.initials: A
authors.lastname: Ramsay
authors.forename: M
authors.initials: M
authors.lastname: Bonnet
authors.forename: L
authors.initials: L
authors.lastname: Gagnidze
authors.forename: W
authors.initials: W
authors.lastname: Githui
authors.forename: F
authors.initials: F
authors.lastname: Varaine
authors.forename: P J
authors.initials: PJ
authors.lastname: Guérin
mesh_terms: D000328:Adult; D003581:Cytodiagnosis / Q000592:standards; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D011446:Prospective Studies; D017678:Sex Distribution; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology