title: A descriptive study of TB cases finding practices in the three largest public general hospitals in Vietnam.
abstract: BACKGROUND
  A project was implemented in 2010 to improve TB notification and TB screening and diagnostic routines in large general hospitals. The aims of present study was to assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam.
  
  
  OBJECTIVE
  To assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam.
  
  
  METHODS
  The study had three elements: 1) Focus group discussions with hospital physicians; 2) review of hospital records and structured interviews of people who had a chest X-ray on any indication; and 3) record reviews and structured interviews of people newly diagnosed with TB.
  
  
  RESULTS
  The most commonly reported diagnostic pathway for pulmonary TB was chest X-ray followed by sputum-smear microscopy. Among 599 individuals who had a chest X-ray performed, 391 (65.1%) had recorded any abnormality, significantly higher in males (73.8%) than in females (54.7%), (p < 0.001), and the proportion was increasing with age (p <0.001). Among those with abnormal chest X-ray, 245 (69.2%) were investigated with sputum smear microscopy, and 49 (20%) were diagnosed with TB, of which 33 (13.5%) were smear-positive.Of 103 consecutive TB cases enrolled in the study, 92 (90%) had chest X-ray as the initial test. Sixty-three (61.2%) fulfilled the TB suspect criteria based on respiratory symptoms (productive cough >2 weeks).
  
  
  CONCLUSIONS
  Chest X-ray is the preferred first test for TB in the largest hospitals in Vietnam. Chest X-ray is a sensitive screening tool for TB, which should be followed by a confirmatory TB test. While the majority of those with chest X-ray abnormalities are investigated with smear-microscopy, the high sputum-smear positivity ratio among them suggests that sputum-smear microscopy is done mainly for persons with quite clear TB signs or symptoms. TB screening and use of confirmatory diagnostic tests on wider indications seem warranted.
authors.affiliation: National Tuberculosis Programme Vietnam, Hanoi, Vietnam. nguyenbinhhoatb@yahoo.com
authors.forename: Hoa
authors.initials: H
authors.lastname: Nguyen Binh
authors.forename: Khanh
authors.initials: K
authors.lastname: Pham Huyen
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hennig
authors.forename: Hanh
authors.initials: H
authors.lastname: Chu Thi
authors.forename: Cuong
authors.initials: C
authors.lastname: Le Xuan
authors.forename: Vu
authors.initials: V
authors.lastname: Le Thuong
authors.forename: Knut
authors.initials: K
authors.lastname: Lönnroth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003955:Diagnostic Tests, Routine / Q000379:methods; D005260:Female; D017144:Focus Groups; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*; D014744:Vietnam; D055815:Young Adult