L G Gawa1, T Reid2, M E Edginton3, M Van Lettow4, M Joshua5, A D Harries6. 1. Dignitas International, Zomba, Malawi ; Zomba Central Hospital, Zomba Ministry of Health, Zomba, Malawi. 2. Operations Research Unit, Médicins Sans Frontières, Operations Center Brussels, Luxembourg. 3. International Union Against Tuberculosis and Lung Disease, Paris, France. 4. Dignitas International, Zomba, Malawi ; University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada. 5. Zomba Central Hospital, Zomba Ministry of Health, Zomba, Malawi. 6. International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
Abstract
SETTING: Zomba Central Hospital, Malawi. OBJECTIVE: To determine diagnostic management and outcomes of pulmonary tuberculosis (PTB) suspects admitted to adult wards. DESIGN: A retrospective, cross-sectional review of medical records of patients admitted to hospital between July and September 2010. RESULTS: There were 141 PTB suspects. Sputum examination was requested and performed in 67 (48%) suspects, but none were smear-positive. Chest X-ray (CXR) was requested and performed in 26 (39%) suspects whose sputum smears were negative. Eleven suspects had a CXR suggestive of PTB: two were started on TB treatment and eight died before treatment started. Human immunodeficiency virus (HIV) status was known for 50 patients (35% of all suspects) on admission, all of whom were HIV-positive. HIV testing was requested for 37 patients, but was only performed in 12, five of whom were HIV-positive. Only one patient was referred for antiretroviral treatment. There were 41 (29%) deaths, eight of whom had probable TB and were not treated. In the remaining 33 patients who died, only nine (27%) had sputum smears examined and four (12%) had a CXR. CONCLUSION: The study shows inadequacies in the diagnostic management of PTB suspects in the Zomba Central Hospital, but suggests opportunities for improvement.
SETTING: Zomba Central Hospital, Malawi. OBJECTIVE: To determine diagnostic management and outcomes of pulmonary tuberculosis (PTB) suspects admitted to adult wards. DESIGN: A retrospective, cross-sectional review of medical records of patients admitted to hospital between July and September 2010. RESULTS: There were 141 PTB suspects. Sputum examination was requested and performed in 67 (48%) suspects, but none were smear-positive. Chest X-ray (CXR) was requested and performed in 26 (39%) suspects whose sputum smears were negative. Eleven suspects had a CXR suggestive of PTB: two were started on TB treatment and eight died before treatment started. Human immunodeficiency virus (HIV) status was known for 50 patients (35% of all suspects) on admission, all of whom were HIV-positive. HIV testing was requested for 37 patients, but was only performed in 12, five of whom were HIV-positive. Only one patient was referred for antiretroviral treatment. There were 41 (29%) deaths, eight of whom had probable TB and were not treated. In the remaining 33 patients who died, only nine (27%) had sputum smears examined and four (12%) had a CXR. CONCLUSION: The study shows inadequacies in the diagnostic management of PTB suspects in the Zomba Central Hospital, but suggests opportunities for improvement.
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