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Free Content Active case finding of undetected tuberculosis among chronic coughers in a slum setting in Kampala, Uganda

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SETTING: Kisenyi slum in peri-urban Kampala, Uganda.

OBJECTIVES: Using chronic cough (≥2 weeks) inquiry as a screening tool to identify undetected smear-positive tuberculosis (TB) cases and to describe the characteristics of smear-positive TB cases detected by active case finding.

DESIGN: A house-to-house survey was conducted in five randomly selected villages in Kampala between June and August 2005. A sample of households was visited; adults aged ≥15 years were consecutively interviewed to identify those with chronic cough. Three sputum specimens were collected and examined by smear microscopy.

RESULTS: Among 930 individuals, we identified 189 (20%) chronic coughers. Of these, we found 33 (18%) undiagnosed smear-positive cases. The newly detected cases had an even sex distribution (P = 0.47), a median age of 30 years, a median cough duration of 1 month and 55% had acid-fast bacilli 1+ sputum smear grade.

CONCLUSION: These findings suggest that active case finding could supplement DOTS to yield additional smear-positive TB cases, lead to early diagnosis and thus shorten the duration of infectiousness before effective chemotherapy is initiated. In communities such as Kisenyi, this is a feasible strategy that may prove useful for TB control, but its cost-effectiveness needs to be evaluated. Early health care seeking for cough should be emphasized.
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Keywords: active case finding; case detection; chronic cough; smear-positive; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA 2: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA; and Makerere University–Case Western University Research Collaboration, Kampala, Uganda

Publication date: April 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 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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