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Free Content Assessment and evaluation of contact as a risk factor for tuberculosis in rural Africa

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SETTING: A rural district in Malawi.

OBJECTIVE: To determine the effect of inaccurate recall on estimates of the proportion of tuberculosis (TB) cases attributable to contact with identifiable prior cases.

DESIGN: Case-control study of laboratory-confirmed TB cases and community controls, comparing family, household and area contacts identified from a database of TB cases with those named at interview. Estimation of prior contact as a risk factor for TB and identified factors associated with being a named contact.

RESULTS: Ninety-five per cent of named contacts were known TB cases. The proportion of total identified contacts who were named at interview was 75%, and was similar for cases and controls. Cases were twice as likely as controls to identify prior contacts. Adding database information did not affect odds ratios, but increased the proportion of TB cases attributable to prior contact. Smear-positive, male and human immunodeficiency virus (HIV) negative TB patients were more likely to be named by subsequent cases. Identifiable recent contact with known smear-positive cases accounted for 12.5% of the TB burden.

CONCLUSIONS: Reporting of putative source contacts showed little evidence of recall bias and gave estimates of the relative risk of TB associated with identifiable contact. The lower likelihood of HIV-positive cases being named as contacts may reflect reduced infectiousness.

Keywords: HIV; Malawi; contact; epidemiology; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Karonga Prevention Study, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, UK 2: London School of Hygiene and Tropical Medicine, London, UK 3: Karonga Prevention Study, Chilumba, Malawi; and London School of Hygiene and Tropical Medicine, London, UK 4: Karonga Prevention Study, Chilumba, Malawi

Publication date: June 1, 2008

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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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