The proportion of patients with short duration cough (2-3 weeks) among newly detected smear-positive pulmonary TB patients; the yield of strategic change in the case detection of revised national tuberculosis control programme in an urban community setting of South India

Abstract

Context: Tuberculosis (TB) is a public health emergency, which challenges the health indicators of India. Revised National Tuberculosis Control Programme (RNTCP) of the country has modified the definition of a pulmonary TB suspect so as to include an additional proportion of people with cough of 2 to 3 weeks duration, which will help in reducing the delay in starting treatment. Aims: To estimate the proportion of people with cough of 2-3 weeks duration among the newly diagnosed sputum-positive TB patients. Settings and Design: It is a community-based, cross-sectional study in the geographical setting of Thiruvanathapuram city corporation area, Kerala, India. Materials and Methods: The defined population in this study was tuberculosis cases registered under RNTCP for 1 year after April 2009 at the Thiruvanathapuram Tuberculosis Unit (TU). Simple random sampling procedure was done from the sampling frame, the registry of sputum-positive pulmonary cases. TB patients were interviewed when they came to the DOTS center to start the treatment. Total duration of treatment was the major outcome variable. The study protocol was approved by institutional ethical committee of government medical college, Thiruvananthapuram. Results: Proportion of people having cough of less than 3 weeks duration among newly detected TB patients and eligible for screening as per the new guideline was 32%. The analysis included data of 194 subjects with a mean (standard deviation) age of 47.5 (14.3) years. Male gender (149, 76.8%), an educational level up to secondary school (172, 88.6%), and people who were either unemployed or manual laborers (96, 49.4%) predominated in the study sample. Conclusions: In short, the study revealed that almost one third of recently diagnosed TB patients would not have been considered as 'TB suspect' before the implementation of the new strategic change. The findings support the new definition of pulmonary TB suspect in RNTCP.