IJCM_275A: Implementation of WHO recommended 4-Symptom Screening Tool for tuberculosis in Northern India

Abstract

Background: World Health Organization (WHO) suggests using symptom- based screening tools to improve early detection of tuberculosis (TB). The WHO recommended 4-symptom screening (W4SS) is one such tool. Although, found to be effective in screening TB among HIV patients, its implementation among general patients have not been well-studied. Objectives: To assess the predictive value of W4SS in TB screening among outpatients and inpatients in North India. Methodology: A prospective cohort study starting July 1, 2023 included patients in the outdoor or indoor of any department (except Chest TB). Patients were screened with W4SS (cough > 2 weeks, fever > 2 weeks, significant weight loss, night sweats). A presumptive TB case (presence of any one symptom), was further examined by the Chest TB consultant, completing the diagnostic algorithm as per National Tuberculosis Elimination Program guidelines for final diagnosis. Data were collected using a semi-structured study proforma and analysed using JAMOVI version 2.0, an open-source software for statistical analysis. Results: During 5 months of data collection, 8609 patients were screened for TB using the W4SS. Of these, 201 (2.3%) were W4SS positive, and of W4SS positive, 25 had confirmed diagnosis of TB. The positive predictive value of W4SS was 12.4% (95% confidence interval 10.9% to 14.1%). Among W4SS positive patients, being unmarried (p value < 0.05), uneducated (p value < 0.05), family history of TB (p value < 0.01), fever (p value < 0.01), significant weight loss (p value < 0.01) and night sweats (p value < 0.01) were significantly associated with final diagnosis of TB. Age, gender, employment and presence of cough were not significantly associated with confirmed diagnosis of TB among W4SS positive patients. Conclusion: W4SS in its present form has limited usability in screening general patients for TB. A multi-centric study is required to improve the scale.