title: Can follow-up examination of tuberculosis patients be simplified? A study in Chhattisgarh, India.
abstract: BACKGROUND
  Each follow-up during the course of tuberculosis treatment currently requires two sputum examinations. However, the incremental yield of the second sputum sample during follow-up of different types of tuberculosis patients has never been determined precisely.
  
  
  OBJECTIVE
  To assess the incremental yield of the second sputum sample in the follow-up of tuberculosis patients under the Revised National Tuberculosis Control Programme (RNTCP) in Chhattisgarh, India.
  
  
  METHODS
  A record review of tuberculosis (TB) patients registered in 2009 using a structured proforma from two sources, Tuberculosis and Laboratory Register, was undertaken in the six districts of Chhattisgarh, India.
  
  
  RESULTS
  In smear positive cases, of 10,048 follow-up examinations, 45 (0.5%) were found to be smear positive only on the second sputum when the result of the first sample was negative. In smear negative pulmonary and extra pulmonary TB patients, of 6,206 follow-up smear examinations, 11(0.2%) were found to be smear positive.
  
  
  CONCLUSIONS
  The incremental yield of a second smear examination was very low, indicating that examination of one sputum sample is enough during follow-up among TB patients. There is insufficient yield to support sputum smear microscopy for monitoring smear negative pulmonary TB and extra pulmonary TB patients. These results indicate that the follow-up smear microscopy can be substantially simplified with favourable resource implications.
authors.affiliation: Office of the World Health Organization Representative in India, WHO Country Office, New Delhi, India. debashishkundu@yahoo.com
authors.forename: Debashish
authors.initials: D
authors.lastname: Kundu
authors.forename: Ajay
authors.initials: A
authors.lastname: M V Kumar
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Puneet Kumar
authors.initials: PK
authors.lastname: Dewan
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Achuthan Nair
authors.forename: Kshitij
authors.initials: K
authors.lastname: Khaparde
authors.forename: Priyakanta
authors.initials: P
authors.lastname: Nayak
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.forename: Marcel
authors.initials: M
authors.lastname: Manzi
authors.forename: Donald A
authors.initials: DA
authors.lastname: Enarson
authors.forename: Madhav Rao
authors.initials: MR
authors.lastname: Deshpande
authors.forename: Sachin
authors.initials: S
authors.lastname: Chandraker
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007194:India; D013048:Specimen Handling; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*