Santha T, Garg R, Subramani R, Chandrasekaran V, Selvakumar N, Sisodia R S, Perumal M, Sinha S K, Singh R J, Chavan R, Ali F, Sarma S K, Sharma K M, Jagtap R D, Frieden T R, Fabio L, Narayanan P R
Tuberculosis Research Center, Chennai, Delhi, India.
Int J Tuberc Lung Dis. 2005 Jan;9(1):61-8.
Governmental health facilities in six districts of India.
To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > or =2 or > or =3 weeks.
Trained health workers questioned each out-patient for presence of cough. Those with cough > or =2 weeks underwent sputum microscopy.
Of 55561 out-patients interviewed, 2210 (4%) had cough > or =2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > or =3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough > or =2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough > or =3 weeks.
The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough > or =3 weeks to > or =2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.
印度六个地区的政府卫生机构。
估计咳嗽的患病率，并比较咳嗽≥2周或≥3周的门诊患者中涂片阳性肺结核（TB）的检出情况。
训练有素的卫生工作者询问每位门诊患者是否咳嗽。咳嗽≥2周的患者接受痰涂片显微镜检查。
在接受访谈的55561名门诊患者中，2210名（4%）咳嗽≥2周，其中267名痰涂片阳性肺结核患者，而咳嗽≥3周的患者中这一数字为182/1370。未自觉主诉咳嗽的患者痰涂片阳性的可能性低于有咳嗽主诉的患者（45/680 [7%] 对222/1530 [15%]，P<0.001），但他们占痰涂片阳性病例的45/267。以咳嗽≥2周作为筛查标准，每个初级和二级卫生保健机构每天估计进行的涂片检查数量分别为8次和19次，而以咳嗽≥3周作为标准时分别为5次和12次。
通过积极询问所有门诊患者的咳嗽病史，以及将门诊患者痰涂片显微镜检查的筛查标准从咳嗽≥3周改为≥2周，痰涂片阳性肺结核病例的检出率可大幅提高。在全国实施这一改变之前，应评估其在项目上的可行性。
