Duration of cough, TB suspects’ characteristics and service factors determine the yield of smear microscopy

Otero, Larissa; Ugaz, R.; Dieltiens, Greet; González, Elsa; Verdonck, Kristien; Seas, Carlos; Deun, Armand Van; Gotuzzo, Eduardo; Stuyft, Patrick Van der

doi:10.1111/j.1365-3156.2010.02645.x

Cited by 11 publications

(18 citation statements)

References 7 publications

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“…We did not further categorize low positivity rate based on time when the sputum was collected (spot or early morning sample), since this DMC is one of the medical colleges based referral health facility where majority of the attendees were referred by medical officers from peripheral health institutions or from private. Hence, the probability of person attending at the late stage of illness is more in these kinds of DMC possible [25]. Person attending at late stage of illness is more likely to have high grade smears.…”

Section: Discussionmentioning

confidence: 99%

Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

Chinnakali

Selvaraj

Thekkur

et al. 2014

Journal of Respiratory Medicine

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Background and Objectives. Low counts are more difficult to find in microscopic sputum examination and thus are more likely to be missed. In this study, we aimed to estimate the proportion of low-count grading and assessing any age and gender differences in sputum smear grading in a low HIV prevalence setting. Materials and Methods. From the tuberculosis laboratory register information on sputum positivity including the grading of smears, age and gender were extracted for January 2011-December 2011. Smears were examined using Ziehl-Neelsen technique and graded as per the Program Guidelines. Positive smears were classified into low grade positive smears (scanty and 1+) and high grade positive smears (2+ and 3+). Differences in grading of smear based on gender and age were analysed using chi square test. Results. Of 9000 smears examined, 8210 (91.2%) were collected as diagnostic smears from tuberculosis suspects. Low grade positivity was 37.5% among diagnostic smears and 69.6% among follow-up smears. Sputum smears from female examinees had higher proportions of low grade positive smears ( = 0.003). Stratification of age and sex within TB suspects had clearly demonstrated the observance of higher low grade positivity among female TB suspects at extremes of age.

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Section: Discussionmentioning

confidence: 99%

Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

Chinnakali

Selvaraj

Thekkur

et al. 2014

Journal of Respiratory Medicine

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“…This may preclude scale-up for use in improved case finding through screening, i.e. a systematic effort to identify unrecognized disease through targeting groups in which TB prevalence is lower [16], [17] than among patients with prolonged TB symptoms reporting to health facilities in high TB incidence countries [18].…”

Section: Introductionmentioning

confidence: 99%

Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis

et al. 2013

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BackgroundHigh costs are a limitation to scaling up the Xpert MTB/RIF assay (Xpert) for the diagnosis of tuberculosis in resource-constrained settings. A triaging strategy in which a sensitive but not necessarily highly specific rapid test is used to select patients for Xpert may result in a more affordable diagnostic algorithm. To inform the selection and development of particular diagnostics as a triage test we explored combinations of sensitivity, specificity and cost at which a hypothetical triage test will improve affordability of the Xpert assay.MethodsIn a decision analytical model parameterized for Uganda, India and South Africa, we compared a diagnostic algorithm in which a cohort of patients with presumptive TB received Xpert to a triage algorithm whereby only those with a positive triage test were tested by Xpert.FindingsA triage test with sensitivity equal to Xpert, 75% specificity, and costs of US$5 per patient tested reduced total diagnostic costs by 42% in the Uganda setting, and by 34% and 39% respectively in the India and South Africa settings. When exploring triage algorithms with lower sensitivity, the use of an example triage test with 95% sensitivity relative to Xpert, 75% specificity and test costs $5 resulted in similar cost reduction, and was cost-effective by the WHO willingness-to-pay threshold compared to Xpert for all in Uganda, but not in India and South Africa. The gain in affordability of the examined triage algorithms increased with decreasing prevalence of tuberculosis among the cohort.ConclusionsA triage test strategy could potentially improve the affordability of Xpert for TB diagnosis, particularly in low-income countries and with enhanced case-finding. Tests and markers with lower accuracy than desired of a diagnostic test may fall within the ranges of sensitivity, specificity and cost required for triage tests and be developed as such.

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“…Sin embargo, en el mismo ámbito de estudio (micro-redes ubicadas en escenarios epidemiológicos de muy alto riesgo de trasmisión) se halló que el rendimiento diagnóstico de la baciloscopia en SR llegó a 1,5% (6) , muy lejos de un rendimiento del 10% establecido como meta en algunas publicaciones (7)(8)(9) y en la versión previa de la norma técnica nacional.…”

Section: Discussionunclassified

“…Dentro de las prácticas, 20% de los profesionales informó que en su establecimiento de salud se solicita 'casi siempre' o 'siempre' muestras de esputo en pacientes que no cumplen con la definición de SR. Este hallazgo sería una de las causas del bajo rendimiento diagnóstico en estos establecimientos de salud en Tacna (6) , y probablemente explicaría los bajos rendimientos de la baciloscopia en otros estudios realizados en los distritos de Santa Anita (4) y San Juan de Lurigancho (7) , en Lima.…”

Section: Discussionunclassified

“…Estudios que estimaron el rendimiento diagnóstico de la baciloscopia en establecimientos de salud de dos distritos de Lima Metropolitana encontraron rendimientos del 2,4% y 7,3% (4,5) . Un estudio realizado en establecimientos de salud ubicados en escenario de 'muy alto riesgo de transmisión' dentro de la región Tacna, encontró un rendimiento de 1,5% (6) .…”

Section: Introductionunclassified

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Conocimientos, percepciones y prácticas de personal de salud en la detección de sintomáticos respiratorios en una región de muy alto riesgo de trasmisión de tuberculosis en el Perú

et al. 2016

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Introducción. Tacna es una región de muy alto riesgo de transmisión de tuberculosis. Sin embargo, se ha encontrado que el rendimiento diagnóstico de la baciloscopia en sus establecimientos de salud es del 1,5%. Objetivo. Describir los conocimientos, percepciones y prácticas sobre detección de sintomáticos respiratorios (SR). Diseño. Estudio transversal. Lugar. Establecimientos de salud de la Dirección Regional de Salud de Tacna. Participantes. Profesionales de salud (médicos y enfermeras). Intervenciones. Cuestionario estructurado auto-administrado y anónimo, elaborado por los autores del estudio en base a la vigente “Norma Técnica de Salud para la Atención Integral de las Personas Afectadas por Tuberculosis”. Principales medidas de resultado. Frecuencia absoluta y relativa de conocimientos adecuados, percepciones y prácticas sobre detección de sintomáticos respiratorios. Resultados. De 178 profesionales de salud (médicos y enfermeras), 89,9% conocían la definición de SR; 93,3% sabía que debe solicitarse dos muestras de esputo a los SR; 22,5% conocía el indicador que evalúa la calidad de detección de SR, y 28,1%, el indicador que evalúa la capacidad del personal para realizar la baciloscopia entre los sintomáticos respiratorios identificados; 49,4% sabía que la meta del indicador de intensidad de búsqueda es 5 por 100 atenciones en mayores de 15 años y 60,8% señaló haber leído la norma técnica vigente. Conclusiones. En el estudio, existió una brecha en el conocimiento de médicos y enfermeras en la detección de sintomáticos respiratorios. Esta brecha fue mayor en el conocimiento sobre los indicadores operacionales de detección.

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Duration of cough, TB suspects’ characteristics and service factors determine the yield of smear microscopy

Cited by 11 publications

References 7 publications

Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

Age and Sex Differences in Sputum Smear Microscopy Results for Acid Fast Bacilli in a Tertiary Care Centre, South India

Optimal Triage Test Characteristics to Improve the Cost-Effectiveness of the Xpert MTB/RIF Assay for TB Diagnosis: A Decision Analysis

Conocimientos, percepciones y prácticas de personal de salud en la detección de sintomáticos respiratorios en una región de muy alto riesgo de trasmisión de tuberculosis en el Perú

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