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Free Content Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India

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SETTING: Governmental health facilities in six districts of India.

OBJECTIVE: To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of ≥2 or ≥3 weeks.

DESIGN: Trained health workers questioned each out-patient for presence of cough. Those with cough ≥2 weeks underwent sputum microscopy.

RESULTS: Of 55561 out-patients interviewed, 2210 (4%) had cough ≥2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough ≥3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough ≥2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough ≥3 weeks.

CONCLUSION: The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough ≥3 weeks to ≥2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.

Keywords: chest symptoms; cough duration; government health facilities; smear-positive tuberculosis

Document Type: Regular Paper

Affiliations: 1: Tuberculosis Research Center, Chennai, India 2: World Health Organization, Delhi, India 3: RNTCP, Jaipur, Rajasthan, India 4: RNTCP, Chennai, Tamil Nadu, India 5: RNTCP, Udaipur, Rajasthan, India; and RNTCP, Pali, Rajasthan, India 6: RNTCP, Pune, Maharashtra, India 7: RNTCP, Pali, Rajasthan, India 8: RNTCP, Udaipur, Rajasthan, India 9: World Health Organization, Geneva, Switzerland

Publication date: January 1, 2005

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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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