title: Comprehensiveness of primary services in the care of infectious tuberculosis patients in Rawalpindi, Pakistan.
abstract: METHODS
  All tuberculosis (TB) diagnostic centres of Rawalpindi District, Pakistan, including five tertiary care hospitals and 16 rural health centres.
  
  
  OBJECTIVE
  To identify among sputum smear-positive patients registered during 2009 in the laboratory register those who had not been recorded in a treatment register, defined in the study as 'initial loss to follow-up'.
  
  
  METHODS
  A retrospective record review of routine TB data.
  
  
  RESULTS
  There were 16 145 suspects screened for TB and recorded in the laboratory registers. Of 1698 smear-positive patients identified in the laboratory registers, 101 (6%) could not be identified in the treatment registers. Eighty-six (10%) of 842 patients in tertiary care hospitals and 15/856 (2%) in rural health centres were not recorded (OR 6.4, 95%CI 3.6-11.6, P < 0.01).
  
  
  CONCLUSIONS
  The study shows a significant association between type of health facility and initial loss to follow-up. In rural health centres, the proportion lost to follow-up is low, reflecting more efficient care than in tertiary care hospitals. Strategies are urgently needed to improve the registration and follow-up of smear-positive cases in tertiary care institutions.
authors.affiliation: Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors.forename: R
authors.initials: R
authors.lastname: Fatima
authors.affiliation: Tuberculosis Control Program Pakistan, Islamabad, Pakistan.
authors.forename: Q
authors.initials: Q
authors.lastname: Ejaz
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: D A
authors.initials: DA
authors.lastname: Enarson
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
keywords: Pakistan; initial loss to follow-up; tuberculosis