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Free Content Is TB contact screening relevant in a developing country setting? Experiences from eastern Nepal, 1996–1998

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SETTING: A tuberculosis programme run by a non-governmental organisation in eight hill and mountain districts of eastern Nepal.

OBJECTIVE: To assess the impact of contact screening on case-finding.

DESIGN: A retrospective cohort study of contacts of smear-positive, smear-negative and extra-pulmonary tuberculosis patients diagnosed and registered during 1996–1998 (‘index cases’). Contacts, defined as household members identified by index cases, were screened by sputum examination; two positive smears were taken to indicate smear-positive pulmonary disease.

RESULTS: Approximately 50% (668) of registered cases identified contacts; 75% (2298) of the contacts identified provided one or more sputum specimens. An overall smear-positive case yield of 0.61% (14) was obtained from contacts tested, all except one of which were contacts of smear-positive index cases. For smear-positive index cases with a smear grading of ≥2+, the yield was 7.2 times greater (P = 0.04) than for those with a grading of 1+.

CONCLUSION: In this setting, sputum examination of household contacts of smear-negative and extra-pulmonary tuberculosis cases is not justified. Further assessment is needed to evaluate the utility of testing contacts of smear-positive cases without symptom screening, and whether cost effectiveness can be improved by restricting testing to contacts of cases with high bacterial (≥2+) loads.
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Keywords: Nepal; contact screening; developing country; tuberculosis

Document Type: Regular Paper

Affiliations: 1: The Britain-Nepal Medical Trust, Biratnagar, Nepal 2: Eastern Mediterranean Region Office, World Health Organisation, Alexandria, Egypt

Publication date: October 1, 2000

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