title: Are patients with pulmonary tuberculosis who are identified through active case finding in the community different than those identified in healthcare facilities?
abstract: The lack of healthcare access contributes to large numbers of tuberculosis (TB) cases being missed and has led to renewed interest in outreach approaches to increase detection. It is however unclear whether outreach activities increase case detection or merely identify patients before they attend health facilities. We compared adults with cough of >2 weeks' duration recruited in health facilities (1202 participants) or in urban slums (2828 participants) in Nigeria. Participants provided demographic and clinical information and were screened using smear microscopy. The characteristics of smear-positive and smear-negative individuals were compared stratified by place of enrolment. Two hundred nine health facility participants (17.4%) and 485 community-based participants (16.9%) were smear positive for pulmonary TB. Community-based smear-positive cases were older (mean age, 36.3 vs. 31.8 years), had longer cough duration (10.3 vs. 6.8 weeks) and longer duration of weight loss (4.6 vs. 3.6 weeks) than facility-based cases; and they complained more of fever (87.4% vs. 74.6%), chest pain (89.0% vs. 67.0%) and anorexia (79.5% vs. 55.5%). Community smear-negative participants were older (mean, 39.4 vs. 34.0 years), were more likely to have symptoms and were more likely to have symptoms of longer duration than smear-negative facility-based participants. Patients with pulmonary TB identified in the community had more symptoms and longer duration of illness than facility-based patients, which appeared to be due to factors differentially affecting access to healthcare. Community-based activities targeted at urban slum populations may identify a different TB case population than that accessing stationary services.
authors.affiliation: Federal Capital Territory Tuberculosis and Leprosy Control Programme, Nigeria.
authors.forename: S T
authors.initials: ST
authors.lastname: Abdurrahman
authors.affiliation: Zankli Medical Centre, Nigeria; Bingham University, Karu, Nassarawa State, Nigeria.
authors.forename: L
authors.initials: L
authors.lastname: Lawson
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: M
authors.initials: M
authors.lastname: Blakiston
authors.affiliation: Nigeria Centre for Disease Control, Abuja, Nigeria.
authors.forename: J
authors.initials: J
authors.lastname: Obasanya
authors.affiliation: Liverpool School of Tropical Medicine, UK; Global Fund to Fight Aids, Tuberculosis and Malaria, Switzerland.
authors.forename: M A
authors.initials: MA
authors.lastname: Yassin
authors.affiliation: Bingham University, Karu, Nassarawa State, Nigeria; University of Liverpool, Liverpool, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Anderson
authors.affiliation: Zankli Medical Centre, Nigeria; Liverpool School of Tropical Medicine, UK.
authors.forename: O
authors.initials: O
authors.lastname: Oladimeji
authors.affiliation: Special Program for Research in Tropical Diseases, WHO/TDR, Geneva, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Ramsay
authors.affiliation: Liverpool School of Tropical Medicine, UK.
authors.forename: L E
authors.initials: LE
authors.lastname: Cuevas
keywords: Adults; Nigeria; clinical presentation; close to community services; facility-based services; tuberculosis