|POTENTIAL YIELD OF PULMONARY TUBERCULOSIS BY DIRECT
MICROSCOPY OF SPUTUM IN A DISTRICT OF SOUTH INDIA
|GVJ Baily, D Savic, GD Gothi, VB Naidu & SS Nair:
Bull WHO 1967, 37, 875 92 & Indian J TB 1968, 15, 130-46.
In the formulation and evolution of a National
Tuberculosis Programme some assumptions are made which require to
be tested under the normal administrative set up with minimum interference
by the investigating team. The objectives of the study were to understand
some operational aspects of Case-finding in the Peripheral Health
Institutions (PHIs) in an integrated programme. First, what is the
frequency of persons showing symptoms suggestive of pulmonary tuberculosis
among the normal out patients attendance (OPA), how many cases can
be found by direct microscopy of sputum of those symptomatics, what
will be the workload of TB Case-finding at a PHI and, what proportion
of symptomatics will be willing to and will actually attend the
District TB Centre (DTC) when referred there for X-ray examination.
The study was conducted in a district with a population of 1.5 million
having one DTC and 55 PHIs. 15 PHIs were selected on the basis of
stratified random sampling. At each PHI an National Tuberculosis
Institute (NTI) investigator worked for a period of one month. All
new out patients were questioned for symptoms (non- suggestive and
suggestive) and any patient with chest symptoms mainly cough for
more than one week fever, chest pain and haemoptysis was subjected
to a sputum examination and also referred for X-ray examination
at the DTC.
It was found that 381 (2.5%) of the 14881 total
new out patients of all age groups complained of cough for 2
weeks and more. From these chest symptomatics, 11% were new cases
of pulmonary tuberculosis. When the symptomatics were referred for
X-ray examination, although 66% agreed to go for X-ray to DTC but
only 16% (of the total referred) actually went for X-ray. Each PHI
had to examine only one or two sputum specimens per working day.
As the study was conducted in a representative sample of PHIs for
a representative duration of time, the material permits the estimation
of the potential yield of cases in a District TB Programme (DTP)
during a period of time (say one year). It was estimated that about
45% of the total estimated prevalence cases in a district
can be diagnosed in a DTP during a period of one year, if all PHIs
function according to the programme recommendations. The workload
due to tuberculosis Case-finding is small and can be managed with
the existing staff and Case-finding by direct smear examination
of sputum at the PHI has to be relied upon.
|KEY WORDS: CASE-FINDING, CHEST SYMPTOMATICS,
PHI, POTENTIAL, WORK LOAD.