Aluoch J A, Oyoo D, Swai O B, Kwamanga D, Agwanda R, Edwards E A, Stott H, Darbyshire J H, Fox W, Sutherland I
Respiratory Diseases Research Centre, Nairobi, Kenya.
Tubercle. 1987 Jun;68(2):93-103. doi: 10.1016/0041-3879(87)90024-9.
This investigation is the seventh in a series of case-finding studies in Kenya. It explores the potential value of questioning mothers attending maternity and child welfare (M & CW) clinics to identify tuberculosis suspects (individuals aged 6 years or more with a cough for 1 month or more or hemoptysis) living in their households. The study was carried out in all the eight M & CW clinics in two divisions (populations 86,000 and 112,000) of two different districts. The mothers were asked to give a standard letter, which explained the possible importance of a chronic cough, to each suspect they identified and invited the suspect to attend the district hospital chest clinic. Each suspect attending the clinic was entered in a special register and two sputum specimens were collected. For those who failed to attend, the specimens were collected at a home visit. Of the total of 342 suspects living in the two study areas who were registered at the M & CW clinics during 1 year, 261 were identified by the mothers but 19 denied having received the standard letter. The remaining 81 had not been identified by mothers but had attended the M & CW clinics on their own initiative. Of the 242 suspects who received the letter, 89 (39%) attended the hospital chest clinic, 74% within a week of the letter being issued from the M & CW clinic. The main reasons given for not attending the hospital chest clinic by the remaining suspects were financial or because their cough had improved or disappeared. Sputum was collected from 238 suspects and examined bacteriologically: in six (2.5%) it was positive for tubercle bacilli on smear and culture and in a further two (0.8%) the sputum was positive on culture only. Of those attending the hospital chest clinic 2.9% were smear- and culture-positive and 4.7% were culture positive. This method of case-finding has yielded disappointing results, for only 4% of the estimated annual incidence of smear-positive cases was detected.
本次调查是在肯尼亚开展的一系列病例发现研究中的第七项。它探讨了询问前往母婴保健诊所的母亲，以识别其家庭中结核病疑似患者（6岁及以上、咳嗽持续1个月及以上或咯血的个体）的潜在价值。该研究在两个不同地区的两个分区的所有八家母婴保健诊所进行（人口分别为8.6万和11.2万）。要求母亲们给她们识别出的每个疑似患者一份标准信件，解释慢性咳嗽的可能重要性，并邀请疑似患者前往地区医院胸科诊所。每个前往诊所的疑似患者都被录入一个特殊登记簿，并采集两份痰标本。对于未前往的患者，在上门访视时采集标本。在一年中在母婴保健诊所登记的两个研究区域的总共342名疑似患者中，261名是由母亲识别出来的，但有19人否认收到标准信件。其余81人未被母亲识别出来，但自行前往了母婴保健诊所。在收到信件的242名疑似患者中，89名（39%）前往了医院胸科诊所，其中74%在母婴保健诊所发出信件后的一周内前往。其余疑似患者未前往医院胸科诊所的主要原因是经济问题，或者是因为他们的咳嗽已经好转或消失。从238名疑似患者那里采集了痰标本并进行细菌学检查：其中6人（2.5%）痰涂片和培养结核杆菌呈阳性，另有2人（0.8%）仅培养呈阳性。在前往医院胸科诊所的患者中，2.9%涂片和培养呈阳性，4.7%培养呈阳性。这种病例发现方法产生了令人失望的结果，因为仅检测到估计涂片阳性病例年发病率的4%。
