title: Sputum smear examination and time to diagnosis in patients with smear-negative pulmonary tuberculosis in the Pacific.
abstract: METHODS
  National tuberculosis programmes (NTPs) in Kiribati and the Marshall Islands, 2006-2010.
  
  
  OBJECTIVE
  To determine the proportion of all tuberculosis (TB) cases that were pulmonary smear-negative, and for these patients to determine how many sputum smears were examined and the time from sputum smear examination to registration.
  
  
  METHODS
  A retrospective cross-sectional study involving a record review of national TB and laboratory registers.
  
  
  RESULTS
  Of 2420 TB cases identified, 709 (29%) were registered as smear-negative pulmonary TB. Of the 695 (98%) with information on smear examination, 222 (32%) had no smear recorded, 61 (9%) had one smear, 86 (12%) two smears and 326 (47%) three smears. Among the 473 patients who had at least one smear, 238 (50%) were registered before sputum examination, 131 (28%) within 1 week, 72 (15%) between 1 and 4 weeks, and 34 (7%) >4 weeks after sputum examination.
  
  
  CONCLUSIONS
  NTPs in Kiribati and the Marshall Islands are diagnosing 29% of all TB patients as smear-negative pulmonary TB. Many patients do not have smears done or are registered before undergoing smear examination. Corrective measures are needed.
authors.affiliation: Secretariat of the Pacific Community, Noumea, New Caledonia.
authors.forename: K
authors.initials: K
authors.lastname: Viney
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; The University of Auckland, Auckland, New Zealand.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: Ministry of Health and Medical Services, Tarawa, Republic of Kiribati.
authors.forename: K
authors.initials: K
authors.lastname: Tabutoa
authors.affiliation: Ministry of Health and Medical Services, Tarawa, Republic of Kiribati.
authors.forename: T
authors.initials: T
authors.lastname: Kienene
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: N N
authors.initials: NN
authors.lastname: Linh
authors.affiliation: Ministry of Health, Majuro, Republic of Marshall Islands.
authors.forename: K
authors.initials: K
authors.lastname: Briand
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
keywords: Pacific; operational research; pulmonary tuberculosis; smear-negative