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Free Content A comprehensive comparison of Ziehl-Neelsen and fluorescence microscopy for the diagnosis of tuberculosis in a resource-poor urban setting

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SETTING: Nairobi City Council Chest Clinic, Kenya.

OBJECTIVES: To establish the efficiency, costs and cost-effectiveness of six diagnostic strategies using Ziehl-Neelsen (ZN) and fluorescence microscopy (FM).

DESIGN: A cross-sectional study of 1398 TB suspects attending a specialised chest clinic in Nairobi subjected to three sputum examinations by ZN and FM. Löwenstein-Jensen culture was used as the gold standard. Cost analysis included health service and patient costs.

RESULTS: Of 1398 suspects enrolled, 993 (71%) had a complete diagnostic work-up involving three sputum specimens for ZN and FM, culture and chest X-ray (CXR). Irrespective of whether ZN or FM was used on one, two or three smears, the overall diagnostic process detected 92% culture-positive cases. Different strategies affected the ratio of smear-positive to smear-negative TB; however, FM was more sensitive than ZN (P < 0.001). FM performance was not affected by the patient's HIV status. The cost per correctly diagnosed smear-positive case, including savings, was US$40.30 for FM on two specimens compared to US$57.70 for ZN on three specimens.

CONCLUSION: The FM method used on one or two specimens is more cost-effective and shortens the diagnostic process. Consequently, more patients can be put on a regimen for smear-positive TB, contributing to improved treatment and reducing transmission.
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Keywords: Ziehl-Neelsen; cost-effectiveness; diagnosis; fluorescence microscopy; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Kenya Medical Research Institute, Center for Respiratory Diseases Research (CRDR), Nairobi, Kenya 2: Department of Health, KIT (Royal Tropical Institute), Amsterdam, The Netherlands 3: Kenya Medical Research Institute, Center for Respiratory Diseases Research (CRDR), Nairobi, Kenya; and Centre for Disease Control and Prevention (CDC), Nairobi, Kenya 4: National Leprosy and Tuberculosis Programme (NLTP), Ministry of Health, Nairobi, Kenya 5: Department of Biomedical Research, KIT, Amsterdam, The Netherlands

Publication date: 2003-12-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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