Desalegn Daniel Melese, Kitila Kumera Terfa, Taddese Boja Dufera, Hailu Tinsae Kidanemariam, Dinku Tariku Takle, Asferie Kassahun Demisse, Balcha Hanna Mekonnen, Gebeyehu Chalachew Sisay, Medhin Girmay
Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia.
Addis Ababa Public Health Research and Emergency Management Core Process, Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia.
Pulm Med. 2019 Mar 20;2019:2905615. doi: 10.1155/2019/2905615. eCollection 2019.
Prolonged laboratory diagnostic process of tuberculosis can lead to failure to complete the diagnosis and increase dropout rate of smear positive pulmonary tuberculosis (PTB) cases. This implies such dropout patients without completing diagnosis are critical as infected individuals remain untreated in the community, providing more opportunities for transmission of the disease and adversely affecting the epidemic. The aim of this research is to determine the level of smear positive PTB diagnosis dropout rate of spot-morning-spot sputum microscopy diagnosis method in public health facilities, in Addis Ababa, Ethiopia.
Retrospective review of patient documents in 13 public health facilities' TB laboratory in Addis Ababa was conducted from October 2011 to March 2016. Data was computerized using Epi-info software and analysed using SPSS version 20.0 software. Descriptive numerical summaries were used to present the findings. Association between the dropout rate and demographic variables was assessed by Chi-square (X). Bivariate model using Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated. P-Value less than 0.05 was taken as statistically significant.
Of 41,884 presumptive TB patients registered during the 53 months for laboratory investigation, 5.9% were positive for the first spot sputum smear microscopy. Among these positive cases, 142 (5.8%) and 298 (12.1%) did not come back to the laboratory to submitted early morning and second spot sputum specimens, respectively. The diagnostic dropout for morning sputum specimen in hospitals was 5.6% (58/1039) and in health centres was 5.9% (84/1424). However, higher proportion of dropout for second spot sputum specimen in hospitals was 16.4% (170/1039), compared to the health centres, 8.9% (128/1424). Diagnostic dropout of sputum smear microscopy had no significant association with sociodemographic variable (P value >0.05), while it had significant association with facility type (P value <0.05).
In this study smear positive pulmonary tuberculosis diagnostic dropout rate was high compared to WHO reported for the new strategy shift implying the importance of shifting to same-day approach. Hence, shifting from conventional to same day is crucial to minimize the TB diagnostic dropout rate in the study area and other similar settings. Further research is needed/recommended in the local setting to compare the yield and dropout rates between same-day and conventional sputum smear microscopy approach.
结核病实验室诊断过程延长可能导致诊断无法完成，并增加涂片阳性肺结核（PTB）病例的失访率。这意味着这些未完成诊断的失访患者至关重要，因为受感染个体在社区中仍未得到治疗，从而为疾病传播提供了更多机会，并对疫情产生不利影响。本研究的目的是确定埃塞俄比亚亚的斯亚贝巴公共卫生机构中痰涂片镜检即时-晨痰-即时诊断方法的涂片阳性PTB诊断失访率水平。
对2011年10月至2016年3月期间亚的斯亚贝巴13个公共卫生机构结核病实验室的患者文件进行回顾性审查。数据使用Epi-info软件进行计算机化处理，并使用SPSS 20.0软件进行分析。采用描述性数值汇总来呈现研究结果。失访率与人口统计学变量之间的关联通过卡方检验（X）进行评估。计算使用比值比（OR）和95%置信区间（CI）的二元模型。P值小于0.05被视为具有统计学意义。
在53个月内登记进行实验室检查的41,884例疑似结核病患者中，5.9%的即时痰涂片镜检呈阳性。在这些阳性病例中，分别有142例（5.8%）和298例（12.1%）未返回实验室提交晨痰和即时痰标本。医院晨痰标本的诊断失访率为5.6%（58/1039），卫生中心为5.9%（84/1424）。然而，医院即时痰标本的失访比例较高，为16.4%（170/1039），而卫生中心为8.9%（128/1424）。痰涂片镜检的诊断失访与社会人口统计学变量无显著关联（P值>0.05），而与机构类型有显著关联（P值<0.05）。
在本研究中，涂片阳性肺结核的诊断失访率高于世界卫生组织报告的新策略转变后的失访率，这意味着转向当日诊断方法的重要性。因此，从传统方法转向当日诊断对于最大限度降低研究地区及其他类似环境中的结核病诊断失访率至关重要。需要/建议在当地环境中进行进一步研究，以比较当日和传统痰涂片镜检方法的检出率和失访率。
