Tuberculosis in Tanzania—A national survey of newly notified cases

Abstract

A survey was carried out in 1978/80 in the same random sample of districts in Tanzania that were surveyed in 1969, to obtain information on: 1. (a) the proportions of patients with pulmonary and extra-pulmonary tuberculosis; 2. (b) the proportion of patients with bacteriologically-positive pulmonary tuberculosis; 3. (c) the proportion of patients with initial drug resistance; 4. (d) the radiographic extent of pulmonary disease; 5. (e) the changes that had occurred in these factors since 1969, and 6. (f) the results of therapy achieved by the routine treatment services. Of 2242 patients in this survey, 91.5 % had pulmonary tuberculosis only, 0.6 had both extra-pulmonary and pulmonary tuberculosis and 7.9 % had extrapulmonary tuberculosis only. Of the 191 patients with extra-pulmonary tuberculosis, 39 % had lymph node involvement, 26 % bone or joint disease and 19 % a pleural effusion. Of the 2064 patients with pulmonary (with or without extra-pulmonary) tuberculosis 96.2 % had no history of previous chemotherapy. The proportion for the patients with extra-pulmonary tuberculosis only was similar. A sputum specimen was produced by 1006 (62 %) of the patients aged 10 years or more with pulmonary tuberculosis; 77.2 % of smear results were positive, as were 68.3 % of the culture results. In every patient with identification test results the strain was Mycobacterium tuberculosis. Of 555 patients with no history of previous chemotherapy and a sensitivity test result available, 10.1 % had a strain resistant to isoniazid and/or streptomycin, namely, 7.6 % to isoniazid alone, 0.7 % to streptomycin alone and 1.8 % to both drugs. Of the 1161 patients with chest radiographs available and a diagnosis.in Tanzania of pulmonary tuberculosis, a lung lesion or a pleural effusion was reported at independent assessment in London for 82 % of patients aged 15 years or more and for 16 % of patients under 15 years of age. For the patients with a pulmonary lesion, the total extent of disease was greater than 1 lung in 37 % of adults and 39 % of children and cavitation was present in 55 % of adults and 21 % of children. A comparison of the pretreatment data in 1978/80 with those from the 1969 survey showed that they were broadly similar in most respects. The results of therapy at one year or later were assessed for 413 patients who had had bacteriological confirmation of their disease in the reference laboratory on admission. At follow-up 40 % had a negative culture and a further 9 % were reported to be cured without bacteriological confirmation. Of the rest, 13 % had died in the first year, 8 % had a positive culture, 5 % were known to be alive but their status was unknown, 21 % were lost from observation and for the remaining 3 % no follow-up information was available.