Pulmonary tuberculosis case detection through fortuitous cough screening during home visits

Abstract

Summary Objective To compare the yield of active tuberculosis (TB) case detection among risk groups during home visits with passive detection among patients at health services. Methods In April 2004, in a first phase, we introduced, active screening for coughing among all family members of patients that were visited at home by their family doctor or nurse for other reasons. Subsequently, from October 2004 onwards, active screening was restricted to family members belonging to groups at risk of TB. Results The overall detection rate of TB increased from 6.7/100 000 during passive detection at health services before the intervention to 26.2/100 000 inhabitants when passive detection was complemented by active case finding. Active screening among risk groups yielded 35 TB cases per 1000 persons screened compared to 20 TB cases per 1000 persons passively screened at health services. Active case finding was particularly efficient in those coughing for 3 weeks or more (107/1000 screened). Conclusion This study demonstrates that active case finding in groups at risk during home visits increases the case detection rate in the population and permits the identification of cases that may not be detected through passive case finding at health facility level.

Spatial Analysis of Pulmonary Tuberculosis in Antananarivo Madagascar: Tuberculosis-Related Knowledge, Attitude and Practice

“…Morrison et al had reported that latent tuberculosis infection was found in 51.4% of contact investigations [20]. Gonzàlez-Ochoa et al found that tracking cases in populations at risk increases rates of case detection [21]. These authors thus illustrate the importance of active detection of tuberculosis by investigating patient contacts.…”

Household Contact Screening and Yield of Tuberculosis Cases—A Clinic Based Study in Chennai, South India

“…However the yield for new TB cases among contacts with abnormal x-ray was high (41%). Many studies have shown that active case finding among household contacts yields substantially more TB cases than passive case detection [12,13,14,15]. The yield for active TB case finding through contact investigations ranged from 0 to 6.9% among household contacts in high burden countries [16, 17].…”

Why test for tuberculosis? A qualitative study from South Africa

“…9 The Zambia South Africa Tuberculosis and HIV/AIDS Reduction (ZAM-STAR) trial, for example, the only study included in the review that directly evaluated impact on TB epidemiology, had inconclusive findings. 10 The same review did, however, find moderate evidence that screening increases the number of cases found in the short term, for example in South Africa, 11 Cambodia 12 and the Netherlands, 13 and that these cases were found earlier, and with less severe disease, in Cuba 14 and Mexico, for example. 15 A World Health Organization (WHO) review 16 found that screening methods could be perceived as beneficial in high-burden communities, whether conducted on the basis of symptoms, chest X-ray or sputum investigation.…”