Active case finding of undetected tuberculosis among chronic coughers in a slum setting in 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.
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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