Screening People with Tuberculosis for High Risk of Severe Illness at Notification: Programmatic Experience from Karnataka, India.

Hemant Deepak Shewade,Hosadurga Jagadish Deepak Murthy,Madhavi Bhargava,Sharath Burugina Nagaraja,Basavarajachar Vanitha,Anurag Bhargava,Suresh G Shastri,Anil Singarajipura,Ramesh Chandra Reddy,Ajay M V Kumar

doi:10.3390/tropicalmed6020102

Abstract

Due to limited availability of diagnostics and capacity, people with tuberculosis do not always undergo systematic assessment for severe illness (requiring inpatient care). In Karnataka (south India), para-medical programme staff used a screening tool to identify people at ‘high risk of severe illness’, defined using indicators of very severe undernutrition, abnormal vital signs and poor performance status (any one): (i) body mass index (BMI) ≤ 14.0 kg/m2 (ii) BMI ≤ 16.0 kg/m2 with bilateral leg swelling (iii) respiratory rate > 24/min (iv) oxygen saturation < 94% (v) inability to stand without support. Of 3020 adults notified from public facilities (15 October to 30 November 2020) in 16 districts, 1531 (51%) were screened (district-wise range: 13–90%) and of them, 538 (35%) were classified as ‘high risk of severe illness’. Short median delays in screening from notification (five days), and all five indicators being collected for 88% of patients, suggests the feasibility of using this tool in programme settings. However, districts with poor screening coverage require further attention. To end tuberculosis deaths, screening should be followed by referral to higher facilities for comprehensive clinical evaluation, to assess the need for inpatient care. Future studies should assess the validity (especially sensitivity in picking severely ill patients) of this screening tool.

Highlights

Tuberculosis (TB) is one of the leading killer due to a single infectious agent.In 2019, there were an estimated 1.4 million TB-related deaths, with an estimated case fatality ratio of 14:100 [1]
While same day notification happened in 72% patients, 5.5% were not started on treatment and 17.3% were transferred out of district after diagnosis for continuation of treatment
For body mass index (BMI), if we replace ‘≤’ with ‘

Summary

Introduction

Tuberculosis (TB) is one of the leading killer due to a single infectious agent.In 2019, there were an estimated 1.4 million TB-related deaths, with an estimated case fatality ratio of 14:100 [1]. Most of the deaths in the high TB burden countries occur ‘early’, within two months of treatment initiation and are primarily due to severe illness and late presentation [4,5,6,7,8,9,10]. These can be averted by detecting the missing 2.7 million people with TB (including drug-resistant forms and those with co-morbidities) as early as possible and treating them appropriately [11]. This has not been systematically done for patients with TB

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Discussion

Conclusion