title: Diagnosis of smear-negative tuberculosis in Nigeria: Do health care workers adhere to the national guidelines?
abstract: OBJECTIVE
  The study sought to assess the extent to which healthcare workers (HCWs) adhere to the National Tuberculosis Program (NTP) guidelines for the diagnosis of smear negative tuberculosis in Nigeria.
  
  
  METHODS
  This was a cross-sectional retrospective desk analysis of case files of 280 smear negative pulmonary TB in six States in southern Nigeria.
  
  
  RESULTS
  About 93% of the 280 patients had their first set of sputum smear microscopy tests done, but only 3.6% had the second set of diagnostic tests as prescribed by the NTP guidelines. Only 45.7% (128/280) received broad spectrum antibiotics after their first smear microscopy. 98% had a chest X-ray done, while 93.6% (262/280) had HIV counseling and testing (HCT), out of which 45.0% were HIV positive. Overall, only 2 patients (0.7%) were diagnosed in strict compliance with the NTP guidelines. There was no significant difference in the pattern of diagnosis of smear negative TB cases and smear positive TB cases.
  
  
  CONCLUSIONS
  The adherence of HCWs to the NTP guidelines for diagnosis of smear negative TB is apparently sub-optimal and needs improvement.
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria. Electronic address: dannyoshi@yahoo.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Oshi
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Chukwu
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Nwafor
authors.affiliation: University of Nigeria, Enugu Campus, Nigeria.
authors.forename: Emmanul N
authors.initials: EN
authors.lastname: Aguwa
authors.affiliation: Department of Community Medicine, Abia State University, Aba Campus, Aba, Nigeria.
authors.forename: Ugochukwu U
authors.initials: UU
authors.lastname: Onyeonoro
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Anthony
authors.initials: A
authors.lastname: Meka
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Joy N
authors.initials: JN
authors.lastname: Ikebudu
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Moses C
authors.initials: MC
authors.lastname: Anyim
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Ekeke
authors.affiliation: University of Nigeria, Enugu Campus, Nigeria.
authors.forename: Babatunde
authors.initials: B
authors.lastname: Omotowo
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Chidubem
authors.initials: C
authors.lastname: Ogbudebe
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Nelson O
authors.initials: NO
authors.lastname: Madichie
keywords: Diagnosis; National guidelines; Smear negative; Tuberculosis