Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India.

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, D.; Friden, T.R.; Fabio, L.; Narayanan, P.R.

International Journal of Tuberculosis and Lung Disease; 2005; 9; 61-68.

Summary: Setting: Governmental health facilities in six districts of India.

Objective: To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > 2 or > 3 weeks.

Design: Trained health workers questioned each out-patient for presence of cough. Those with cough > 2 weeks underwent sputum microscopy.

Results: Of 55561 out-patients interviewed, 2210 (4%) had cough > 2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > 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 > 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 > 3 weeks.

Conclusion: 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 > 3 weeks to > 2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.

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