To determine quality of diagnosis and monitoring of treatment response of patients with smear-negative pulmonary tuberculosis (TB) compared with smear-positive cases in Ethiopia.
Methods
A retrospective analysis of medical records of newly diagnosed pulmonary TB cases that were registered for taking anti-TB medication and had completed treatment between 2010 and 2012. We evaluated the percentage of cases that were managed according to the International Standards of Tuberculosis Care (ISTC) and compared smear-negative with smear-positive cases.
Results
We analysed 1168 cases of which 742 (64%) were sputum smear-negative cases. Chest radiography examination at diagnosis and microbiological testing at the end of the intensive phase of treatment was performed in a smaller proportion than in smear-positive TB cases (70% vs. 79%, P value <0.001) and (70% vs. 95%, P value <0.001), respectively.
Conclusions
Clinical actions recommended in the ISTC are of greatest importance in minimising pitfalls in care of smear-negative TB yet were performed less often in smear-negative than smear-positive TB cases.
World Health Organization. Global Tuberculosis Report, Geneva: WHO, 2012.
2.
International Standards for Tuberculosis Care. International Standards for Tuberculosis Care (ISTC), 2nd edn. The Hague: Tuberculosis Coalition for Technical Assistance, 2009.
3.
World Health Organization. Treatment of Tuberculosis Guidelines, 4th edn. Geneva: WHO, 2010.
4.
TiemersmaEWvan der WerfMJBorgdorffMWWilliamsBGNagelkerkeNJ. Natural history of tuberculosis: duration and fatality of untreated pulmonary tuberculosis in HIV negative patients: a systematic review. PLoS One2011; 6: e17601–e17601.
5.
ShahNSCavanaughJSPrattRCainKPWellsCLasersonK. Epidemiology of smear-negative pulmonary tuberculosis in the United States, 1993–2008. Int J Tuberc Lung Dis2012; 16: 1234–1240.
6.
BerhaneY. The AIDS pandemic is still expanding its horizon: comprehensive, harmonized and large scale responses needed. Ethiop J Health Dev2004; 18: 67–70.
7.
Federal Ministry of Health. Tuberculosis, TB/HIV and Leprosy Prevention and Control Strategic Plan, 2007/8 – 2009/10, Addis Ababa: Federal Ministry of Health, 2007.
8.
LawnSDBekkerLGMiddelkoopKMyerLWoodR. Impact of HIV infection on the epidemiology of tuberculosis in a peri-urban community in South Africa: the need for age-specific interventions. Clin Infect Dis2006; 42: 1040–1047.
9.
ScottLEMcCarthyKGousNNdunaMVan RieASanneI. Comparison of Xpert MTB/RIF with other nucleic acid technologies for diagnosing pulmonary tuberculosis in a high HIV prevalence setting: a prospective study. PLoS Med2011; 8: e1001061–e1001061.
10.
Federal Ministry of Health. Guidelines for Clinical and Programmatic Management of TB, Leprosy and TB/HIV in Ethiopia, Addis Ababa: Federal Minsitry of Health, 2012.
11.
AshkinDHollenderESNaritaM. “Won't get fooled again” (by tuberculosis). Chest1999; 116: 856–857.
12.
HongoroCMcPakeBVickermanP. Measuring the quality of hospital tuberculosis services: a prospective study in four Zimbabwe hospitals. Int J Qual Health Care2005; 17: 287–292.
13.
ChungWSChangREGuoHR. Variations of care quality for infectious pulmonary tuberculosis in Taiwan: a population based cohort study. BMC Public Health2007; 7: 107–107.
14.
MalaGMoserADinantGJSpigtM. Why tuberculosis service providers do not follow treatment guideline in Ethiopia: a qualitative study. J Eval Clin Pract2014; 20: 88–93.
15.
UplekarMJuvekarSMorankarSRanganSNunnP. Tuberculosis patients and practitioners in private clinics in India. Int J Tuberc Lung Dis1998; 2: 324–329.
16.
World Health Organization. Involving private practitioners in tuberculosis control issues; interventions, and emerging policy framework, Geneva: WHO, 2001.
17.
SotoASolariLGotuzzoEAcinelliRVargasDVan der StuyftP. Performance of an algorithm based on WHO recommendations for the diagnosis of smear-negative pulmonary tuberculosis in patients without HIV infection. Trop Med Int Health2011; 16: 424–430.
18.
GallardoCRRigauDIrfanAFerrerACaylaJABonfillX. Quality of tuberculosis guidelines: urgent need for improvement. Int J Tuberc Lung Dis2010; 14: 1045–1051.
19.
AhmadRAMatthysFDwihardianiBRintiswatiNde VlasSJMahendradhataY. Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia. BMC Public Health2012; 12: 132–132.
20.
AberVRAllenBWMitchisonDAAyumaPEdwardsEAKeyesAB. Quality control in tuberculosis bacteriology. 1. Laboratory studies on isolated positive cultures and the efficiency of direct smear examination. Tubercle1980; 61: 123–133.
21.
SiddiqiKLambertMLWalleyJ. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis2003; 3: 288–296.
22.
GilpinCKimSJLumbRRiederHLVan DeunA. Working Group on Sputum Smear Microscopy. Critical appraisal of current recommendations and practices for tuberculosis sputum smear microscopy. Int J Tuberc Lung Dis2007; 11: 946–952.
23.
KhanMSDarOSismanidisCShahKGodfrey-FaussettP. Improvement of tuberculosis case detection and reduction of discrepancies between men and women by simple sputum-submission instructions: a pragmatic randomised controlled trial. Lancet2007; 369: 1955–1960.
24.
PrasadRNautiyalRGMukherjiPKJainASinghKAhujaRC. Treatment of new pulmonary tuberculosis patients: what do allopathic doctors do in India?Int J Tuberc Lung Dis2002; 6: 895–902.
25.
PiotM. A simulation model of case finding and treatment in tuberculosis control programmes, Geneva: WHO, 1967.
