Abstract
BackgroundA project was implemented in 2010 to improve TB notification and TB screening and diagnostic routines in large general hospitals. The aims of present study was to assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam.ObjectivesTo assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam.MethodThe study had three elements: 1) Focus group discussions with hospital physicians; 2) review of hospital records and structured interviews of people who had a chest X-ray on any indication; and 3) record reviews and structured interviews of people newly diagnosed with TB.ResultsThe most commonly reported diagnostic pathway for pulmonary TB was chest X-ray followed by sputum-smear microscopy. Among 599 individuals who had a chest X-ray performed, 391 (65.1%) had recorded any abnormality, significantly higher in males (73.8%) than in females (54.7%), (p < 0.001), and the proportion was increasing with age (p <0.001). Among those with abnormal chest X-ray, 245 (69.2%) were investigated with sputum smear microscopy, and 49 (20%) were diagnosed with TB, of which 33 (13.5%) were smear-positive.Of 103 consecutive TB cases enrolled in the study, 92 (90%) had chest X-ray as the initial test. Sixty-three (61.2%) fulfilled the TB suspect criteria based on respiratory symptoms (productive cough >2 weeks).ConclusionChest X-ray is the preferred first test for TB in the largest hospitals in Vietnam. Chest X-ray is a sensitive screening tool for TB, which should be followed by a confirmatory TB test. While the majority of those with chest X-ray abnormalities are investigated with smear-microscopy, the high sputum-smear positivity ratio among them suggests that sputum-smear microscopy is done mainly for persons with quite clear TB signs or symptoms. TB screening and use of confirmatory diagnostic tests on wider indications seem warranted.
Highlights
A project was implemented in 2010 to improve TB notification and TB screening and diagnostic routines in large general hospitals
Among 599 individuals who had a chest X-ray performed, 391 (65.1%) had recorded any abnormality, significantly higher in males (73.8%) than in females (54.7%), (p < 0.001), and the proportion was increasing with age (p
This paper reports on an assessment of the current procedures for TB screening and diagnosis in the three public general hospitals at a point in time when project implementation had started, but with main focus on full notification of all diagnosed cases
Summary
A project was implemented in 2010 to improve TB notification and TB screening and diagnostic routines in large general hospitals. The aims of present study was to assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam. In 2010, the estimated incidence of all forms of tuberculosis (TB) in Vietnam was 199/100,000 population, and the estimated case detection rate of all forms of TB was 54% [1]. In 2006–2007, the Vietnam NTP carried out a combined TB prevalence and tuberculin survey. The survey found a prevalence of smear-positive tuberculosis of 145/ 100,000 (95% CI: 110–180) [3]. This number was 1.6 times higher than the 2006 estimate (89/100,000). A significant number of tuberculosis cases remain undiagnosed and present a potential source of transmission in the community [3]
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