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Free Content Sputum, sex and scanty smears: new case definition may reduce sex disparities in smear-positive tuberculosis

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SETTING: Urban clinic, Nairobi.

OBJECTIVES: To evaluate the impact of specimen quality and different smear-positive tuberculosis (TB) case (SPC) definitions on SPC detection by sex.

DESIGN: Prospective study among TB suspects.

RESULTS: A total of 695 patients were recruited: 644 produced ≥1 specimen for microscopy. The male/female sex ratio was 0.8. There were no significant differences in numbers of men and women submitting three specimens (274/314 vs. 339/380, P = 0.43). Significantly more men than women produced a set of three ‘good’ quality specimens (175/274 vs. 182/339, P = 0.01). Lowering thresholds for definitions to include scanty smears resulted in increases in SPC detection in both sexes; the increase was significantly higher for women. The revised World Health Organization (WHO) case definition was associated with the highest detection rates in women. When analysis was restricted only to patients submitting ‘good’ quality specimen sets, the difference in detection between sexes was on the threshold for significance (P = 0.05).

CONCLUSIONS: Higher SPC notification rates in men are commonly reported by TB control programmes. The revised WHO SPC definition may reduce sex disparities in notification. This should be considered when evaluating other interventions aimed at reducing these. Further study is required on the effects of the human immuno-deficiency virus and instructed specimen collection on sex-specific impact of new SPC definition.
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Keywords: HIV; diagnosis; gender; microscopy; sex; sputum; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Liverpool School of Tropical Medicine, Liverpool, UK 2: Epicentre, Paris, France 3: Kenya Medical Research Institute, Nairobi, Kenya 4: Médecins Sans Frontières, Paris, France

Publication date: May 1, 2009

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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 lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

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

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