title: Diagnostic management and outcomes of pulmonary tuberculosis suspects admitted to a central hospital in Malawi.
abstract: METHODS
  Zomba Central Hospital, Malawi.
  
  
  OBJECTIVE
  To determine diagnostic management and outcomes of pulmonary tuberculosis (PTB) suspects admitted to adult wards.
  
  
  METHODS
  A retrospective, cross-sectional review of medical records of patients admitted to hospital between July and September 2010.
  
  
  RESULTS
  There were 141 PTB suspects. Sputum examination was requested and performed in 67 (48%) suspects, but none were smear-positive. Chest X-ray (CXR) was requested and performed in 26 (39%) suspects whose sputum smears were negative. Eleven suspects had a CXR suggestive of PTB: two were started on TB treatment and eight died before treatment started. Human immunodeficiency virus (HIV) status was known for 50 patients (35% of all suspects) on admission, all of whom were HIV-positive. HIV testing was requested for 37 patients, but was only performed in 12, five of whom were HIV-positive. Only one patient was referred for antiretroviral treatment. There were 41 (29%) deaths, eight of whom had probable TB and were not treated. In the remaining 33 patients who died, only nine (27%) had sputum smears examined and four (12%) had a CXR.
  
  
  CONCLUSIONS
  The study shows inadequacies in the diagnostic management of PTB suspects in the Zomba Central Hospital, but suggests opportunities for improvement.
authors.affiliation: Dignitas International, Zomba, Malawi ; Zomba Central Hospital, Zomba Ministry of Health, Zomba, Malawi.
authors.forename: L G
authors.initials: LG
authors.lastname: Gawa
authors.affiliation: Operations Research Unit, Médicins Sans Frontières, Operations Center Brussels, Luxembourg.
authors.forename: T
authors.initials: T
authors.lastname: Reid
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: M E
authors.initials: ME
authors.lastname: Edginton
authors.affiliation: Dignitas International, Zomba, Malawi ; University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Van Lettow
authors.affiliation: Zomba Central Hospital, Zomba Ministry of Health, Zomba, Malawi.
authors.forename: M
authors.initials: M
authors.lastname: Joshua
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: Malawi; PTB suspects; diagnosis; management; outcomes