SETTING: Thirty-seven hospitals in Malawi. OBJECTIVE: To audit the hospital practice of clinically diagnosing adults with smear-negative pulmonary tuberculosis (PTB). DESIGN: A cross-sectional survey of adults aged 15 years or above who were registered and receiving inpatient treatment for smear-negative PTB. An assessment of each patient was carried out to determine 1) the number of recommended diagnostic guidelines (cough >3 weeks, no response to antibiotics, negative sputum smears and a chest radiograph compatible with PTB) used by hospital staff in making the diagnosis of PTB, and 2) whether the clinical diagnosis of smear-negative PTB was correct according to criteria set by the study. RESULTS: There were 259 patients, 127 men and 132 women, with a mean age of 37 years; 93% had a cough >3 weeks, 95% had received one or more courses of antibiotics, 92% had submitted sputum samples for smear examination and 97% had chest radiographs performed. In 148 (57%) patients, all four diagnostic guidelines were used, and in 238 (92%) patients three or more were used. The diagnosis of smear-negative PTB was considered correct by study criteria in 203 (78%) patients. In the remainder, 22 (8%) were considered to have extrapulmonary TB and 34 (14%) another diagnosis. CONCLUSION: Hospital practices in the diagnosis of smear-negative PTB are reasonable, although there is room for improvement with in-service training and regular audits of practice.
SETTING: Thirty-seven hospitals in Malawi. OBJECTIVE: To audit the hospital practice of clinically diagnosing adults with smear-negative pulmonary tuberculosis (PTB). DESIGN: A cross-sectional survey of adults aged 15 years or above who were registered and receiving inpatient treatment for smear-negative PTB. An assessment of each patient was carried out to determine 1) the number of recommended diagnostic guidelines (cough >3 weeks, no response to antibiotics, negative sputum smears and a chest radiograph compatible with PTB) used by hospital staff in making the diagnosis of PTB, and 2) whether the clinical diagnosis of smear-negative PTB was correct according to criteria set by the study. RESULTS: There were 259 patients, 127 men and 132 women, with a mean age of 37 years; 93% had a cough >3 weeks, 95% had received one or more courses of antibiotics, 92% had submitted sputum samples for smear examination and 97% had chest radiographs performed. In 148 (57%) patients, all four diagnostic guidelines were used, and in 238 (92%) patients three or more were used. The diagnosis of smear-negative PTB was considered correct by study criteria in 203 (78%) patients. In the remainder, 22 (8%) were considered to have extrapulmonary TB and 34 (14%) another diagnosis. CONCLUSION: Hospital practices in the diagnosis of smear-negative PTB are reasonable, although there is room for improvement with in-service training and regular audits of practice.
Authors: Hannock Tweya; Henry Kanyerere; Anne Ben-Smith; John Kwanjana; Andreas Jahn; Caryl Feldacker; Dickman Gareta; Limbani Mbetewa; Mathew Kagoli; Mike Tikhalenawo Kalulu; Ralf Weigel; Sam Phiri; Mary Edginton Journal: PLoS One Date: 2011-12-14 Impact factor: 3.240
Authors: Eunice W Mailu; Philip Owiti; Serge Ade; Anthony D Harries; Marcel Manzi; Eunice Omesa; Polly Kiende; Stephen Macharia; Irene Mbithi; Maureen Kamene Journal: Trans R Soc Trop Med Hyg Date: 2019-12-01 Impact factor: 2.184
Authors: Henry Kanyerere; Anthony D Harries; Katie Tayler-Smith; Andreas Jahn; Rony Zachariah; Frank M Chimbwandira; James Mpunga Journal: Trop Med Int Health Date: 2015-11-16 Impact factor: 2.622
Authors: Stephanie Bjerrum; Frank Bonsu; Nii Nortey Hanson-Nortey; Ernest Kenu; Isik Somuncu Johansen; Aase Bengaard Andersen; Lars Bjerrum; Dorte Jarbøl; Anders Munck Journal: Glob Health Action Date: 2016-08-26 Impact factor: 2.640