title: Quality of diagnosis and monitoring of tuberculosis in Northern Ethiopia: medical records-based retrospective study.
abstract: OBJECTIVE
  To determine quality of diagnosis and monitoring of treatment response of patients with smear-negative pulmonary tuberculosis (TB) compared with smear-positive cases in Ethiopia.
  
  
  METHODS
  A retrospective analysis of medical records of newly diagnosed pulmonary TB cases that were registered for taking anti-TB medication and had completed treatment between 2010 and 2012. We evaluated the percentage of cases that were managed according to the International Standards of Tuberculosis Care (ISTC) and compared smear-negative with smear-positive cases.
  
  
  RESULTS
  We analysed 1168 cases of which 742 (64%) were sputum smear-negative cases. Chest radiography examination at diagnosis and microbiological testing at the end of the intensive phase of treatment was performed in a smaller proportion than in smear-positive TB cases (70% vs. 79%, P value <0.001) and (70% vs. 95%, P value <0.001), respectively.
  
  
  CONCLUSIONS
  Clinical actions recommended in the ISTC are of greatest importance in minimising pitfalls in care of smear-negative TB yet were performed less often in smear-negative than smear-positive TB cases.
authors.affiliation: MSc, Department of Medicine, Mekelle University, Mek'ele, Ethiopia MSc, Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands george.mala@maastrichtuniversity.nl.
authors.forename: George
authors.initials: G
authors.lastname: Mala
authors.affiliation: PhD, Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands PhD, Department of General Practice, Tromsø University, Tromsø, Norway.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Spigt
authors.affiliation: MD, Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
authors.forename: Luc G
authors.initials: LG
authors.lastname: Gidding
authors.affiliation: MD, Department of Surgery, Universidad de Alcala, Alcala, Spain.
authors.forename: Roman
authors.initials: R
authors.lastname: Blanco
authors.affiliation: MD, PhD, Department of Family Medicine, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005002:Ethiopia; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000382:microbiology; D055815:Young Adult
keywords: Quality deficits; healthcare facility; performance indicators; standards