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Free Content Can tuberculosis case finding among health-care seeking adults be improved? Observations from Bissau

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SETTING: The Bandim Health Project study area in Bissau, Guinea-Bissau.

OBJECTIVE: To assess the potential usefulness of predictors (elsewhere applied) and clinical scores (TBscore and TBscore II) based on signs and symptoms typical of tuberculosis (TB) in case finding.

DESIGN: Observational prospective cohort study of patients with signs and symptoms suggestive of pulmonary TB (PTB) from 2010 to 2012.

RESULTS: We included 1089 PTB suspects with a mean age of 34 years (95%CI 33–35); human immunodeficiency virus (HIV) prevalence was 15.1%. PTB was diagnosed in 107 suspects (76.4% sputum smear-positive, 25.2% HIV-infected). Cough > 2 weeks had the highest diagnostic ability (area under the receiver operating characteristic curve [AUC] 0.66, 95%CI 0.62–0.71), while TBscore < 3 best excluded PTB (negative likelihood ratio [LR−] 0.3) when HIV status was not known. TBscore II ≥ 3 had the highest diagnostic ability in HIV-infected PTB suspects (AUC 0.62, 95%CI 0.53–0.72), while the absence of self-reported weight loss best excluded PTB (LR− 0.2). Cough > 2 weeks as a trigger for smear microscopy missed 32.1% of smear-positive PTB cases.

CONCLUSION: Case finding could be improved by screening symptomatic adults for cough and/or weight loss using TBscore II as the trigger for smear microscopy. To suspect PTB only in patients with cough > 2 weeks (non-HIV-infected) or with current cough, fever, weight loss or night sweats (HIV-infected) was not effective in patients whose HIV status was unknown at first visit.
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Keywords: diagnosis; health status indicator; low-resource settings

Document Type: Research Article

Affiliations: 1: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark 2: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark 3: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau 4: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark 5: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark 6: Bandim Health Project, International Network for the Demographic Evaluation of Populations and Their Health in Developing Countries Network, Bissau, Guinea-Bissau; GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark

Publication date: 01 March 2014

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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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