Kakaire A. Kirunda
24 June 2009
Identifying individuals with chronic cough lasting over two weeks to test them for tuberculosis (Active Case Finding) could supplement the current strategy where suspects voluntarily avail themselves to health facilities (Passive Case Finding) for diagnosis.
This is according to a paper by Makerere University School of Public Health and Case Western Reserve University researchers based on a study in the Kampala slum of Kisenyi. The research employed chronic cough (lasting two or more weeks) inquiry as a screening tool to identify undetected smear-positive tuberculosis (TB) cases and to describe the characteristics of smear-positive TB cases detected by active case finding (ACF).
Among 930 individuals, 189 (20 per cent) were identified as chronic coughers. And of these, 33 (18 per cent) were identified as undiagnosed smear-positive cases. "These findings suggest that active case finding could supplement DOTS (Directly observed treatment shortcourse) to yield additional smear-positive TB cases, lead to early diagnosis and thus shorten the duration of infectiousness before effective chemotherapy is initiated," concludes the study published this year in the International Journal of Tuberculosis and Lung Disease. "In communities such as Kisenyi, this is a feasible strategy that may prove useful for TB control, but its cost-effectiveness needs to be evaluated. Early health care seeking for cough should be emphasised."
The researchers observed that the usefulness of Passive Case Finding (PCF) used by most high burden countries such as Uganda is hampered by patient and health system delays and perhaps underlying HIV infections which often lead to delay in diagnosis.
"The delay poses public health concerns because it increases the risk of TB transmission to patients' contacts and death, especially in TB - HIV co infected individuals. ACF can be employed as a supplementary approach to curtail diagnostic delay in high burden settings," wrote the researchers.
None-the-less, despite its being curable, tuberculosis kills 92 out of every 100,000 Ugandans who are a part of an estimated 1.6 million people who die around the world each year, statistics from the World Health Organisation indicate.
Speaking at a recent regional tuberculosis workshop that drew participants from Uganda, Kenya, Tanzania and Ethiopia, Dr Francis Adatu, the manager of the National Tuberculosis and Leprosy Programme at the Ministry of Health said there was only a 50.2 per cent detection rate of tuberculosis in Uganda, far below the World Health Organisation's recommended 70 per cent.
Dr Adatu added: "Prevalence of TB infection stands at 600 per 100,000 people and incidence is 152 per 100,000 population, with the highest affected age group being 20-45. And treatment success stands at 69 per cent, short of the WHO standard requirement of 85 per cent."
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