Prevalence Of Smear Positive Tuberculosis Research Articles

Assessment of Smear-Positive Pulmonary Tuberculosis and Associated Factors among Patients Visiting Health Facilities of Gedeo Zone, Southern Ethiopia: A Cross-Sectional Study.

Tuberculosis (TB) was one of the top causes of ill health and the leading cause of deaths worldwide until the coronavirus (COVID-19) pandemic. Hence, this study is aimed at assessing the prevalence of sputum smear-positive TB and associated factors among TB-suspected patients attending in Gedeo Zone health facilities, Southern Ethiopia. A facility-based cross-sectional study was conducted among 220 TB-suspected patients in Gedeo Zone health facilities from July 01 to Sep 30, 2021. Patients were grouped as smear positive if one sputum out of two was positive or two sputum smears became positive. Various descriptive statistics were computed using the SPSS-25, and factors to smear positivity were identified by multivariable logistic regression analysis. Odds ratio at 95% CI and p values < 0.05 were considered as indicators of statistical association. The overall prevalence of smear-positive TB in Gedeo Zone health facilities was 18.2%, which is significantly high, and the MTB detection rate of GeneXpert was 29.5%. Contact with a TB patient, cigarette smoking, and previously treatment for TB were factors significantly associated with smear-positive TB. The prevalence rate of smear-positive PTB in the study area was 18.2% and 29.5% by direct sputum AFB and sputum GeneXpert, respectively. As a result, we recommend intervention on the identified associated risk factors and further studies to ascertain risk factors and their magnitude at the community level.

National population-based tuberculosis prevalence survey in Ghana, 2013.

BACKGROUND: The prevalence of tuberculosis (TB) disease is one of the three main indicators used to assess the epidemiological burden of TB and the impact change of TB control; the other two are incidence and mortality.OBJECTIVE: To estimate the prevalence of TB disease among adults in Ghana.METHODS: A nationally representative cross-sectional survey was conducted. Participants were screened for TB using interview and chest X-ray (CXR). For those participants with cough ≥2 weeks and/or abnormal CXR, spot and morning sputum specimens were collected and examined by smear microscopy and culture.RESULTS: The study revealed that the prevalence of smear-positive TB among adults (age ≥15 years) was 111 (95%CI 76-145) and that of bacteriologically confirmed TB was 356 (95%CI 288-425) per 100 000 population. Males and older people had a higher prevalence than their counterparts. The majority of TB cases were smear-negative and had an abnormal CXR without reported chronic cough.CONCLUSION: The survey revealed much higher TB disease burden than previously estimated. This implies that the programme needs more effort and resources to find undiagnosed and unreported cases. The higher proportion of smear-negative and asymptomatic TB cases suggests the need to revise the existing screening and diagnostic algorithms.

Population-Based Tuberculosis Disease Prevalence Survey in Ghana: The Role and Lessons Learnt from the Laboratory

Background: Bacteriologically-confirmed tuberculosis (TB) cases used in calculating TB prevalence in a country are obtained through laboratory examination of sputum specimens. Objective: This article describes laboratory processing of specimens, results overview, conclusions and key lessons learnt from the perspective of laboratory personnel involved in the conduct of TB disease prevalence survey in Ghana in 2013. Methods: Symptoms screening and Chest X-ray suggestive of TB were used to select participants who produced sputum to confirm TB cases using microscopy, culture and Xpert® MTB/RIF assay (GeneXpert). Results: A total of 15,935 single and paired sputum specimens were received from eligible participants. About half of Ziehl-Nielsen (129/263) and Auramine O (122/246) stained smear positives were scanty positive. Culture positivity rate for Mycobacterium tuberculosis complex was 266/14,994 (1.7%) and 100/15,179 (0.7%) in Mycobacterial Growth Indicator Tube (MGIT) and Lowenstein-Jensen (LJ) media respectively; while non-tuberculous mycobacterium was 294/14,994 (1.96%) and 167/15,179 (1.1%). Total contamination rates in MGIT (5.4%) were higher than in LJ (1.7%). Prevalence of smear positive TB and bacteriologically confirmed TB among adult population (≥15 years) was estimated at 111 (95% CI: 76 - 145) and 356 (95% CI: 288 - 425) per 100,000 population respectively. Conclusions and Lessons Learnt: Direct supervision of specimen collection by well-trained laboratory personnel, timely transportation of specimens from field to laboratory, prompt specimen processing and use of electronic data management systems are essential for a reliable TB disease prevalence survey data. More importantly, strengthening human and logistical capacity of the laboratory must be of utmost priority.

Smear-Positive Tuberculosis Prevalence and Associated Factors among Pregnant Women Attending Antinatal Care in North Gondar Zone Hospitals, Ethiopia.

Tuberculosis is an ancient infectious disease that remains a threat to public health around the world. It is a contagious airborne disease caused by Mycobacterium tuberculosis complex. In high tuberculosis burden countries, the prevalence of tuberculosis was 10-fold higher in the HIV-infected mothers than that in those not infected with HIV. However, little is known about the burden of tuberculosis (TB) and associated factors in women of reproductive age in most resource poor countries. Therefore, this study aims to investigate prevalence of smear-positive TB and factors associated in pregnant women attending antenatal care in North West, Ethiopia. An institution-based cross-sectional study was conducted in three governmental hospitals of the North Gondar Zone, and a total of 1272 pregnant women attending antenatal care were included. Data were collected by trained personnel's using a pretested and structured symptom screening questionnaire; then, spot-morning-spot sputum samples were collected from those pregnant women who had two or more weeks of cough, and sputum smear was done by using a light-emitted diode fluorescent microscope. 99% of the pregnant women visited the hospitals for antenatal care. The prevalence of smear-positive tuberculosis was 864/100,000 population, and HIV positivity (AOR = 7.24; 95% CI: (2.01–26.03)), urban residence (AOR = 2.28; 95% CI: (1.419–3.158)), and family history of TB (AOR = 2.12; 95% CI: (1.371–3.451)) were significantly associated with smear-positive tuberculosis. In this study, the prevalence of smear-positive tuberculosis was found to be higher than that in other community-based studies in the country. Therefore, health education, targeted screening of pregnant women for TB, and collaboration of TB-HIV clinic with antenatal care clinic should be implemented in the area. Further research should also be conducted for better understanding of the magnitude of tuberculosis in females of reproductive age.

Estimating tuberculosis incidence from primary survey data: a mathematical modeling approach.

SUMMARYBACKGROUND:There is an urgent need for improved estimations of the burden of tuberculosis (TB).OBJECTIVE:To develop a new quantitative method based on mathematical modelling, and to demonstrate its application to TB in India.DESIGN:We developed a simple model of TB transmission dynamics to estimate the annual incidence of TB disease from the annual risk of tuberculous infection and prevalence of smear-positive TB. We first compared model estimates for annual infections per smear-positive TB case using previous empirical estimates from China, Korea and the Philippines. We then applied the model to estimate TB incidence in India, stratified by urban and rural settings.RESULTS:Study model estimates show agreement with previous empirical estimates. Applied to India, the model suggests an annual incidence of smear-positive TB of 89.8 per 100 000 population (95%CI 56.8–156.3). Results show differences in urban and rural TB: while an urban TB case infects more individuals per year, a rural TB case remains infectious for appreciably longer, suggesting the need for interventions tailored to these different settings.CONCLUSIONS:Simple models of TB transmission, in conjunction with necessary data, can offer approaches to burden estimation that complement those currently being used.

Prevalence of Smear-Positive Tuberculosis among Patients Who Visited Saint Paul's Specialized Hospital in Addis Ababa, Ethiopia.

Background Tuberculosis (TB) continues to be a health problem in both developed and developing countries, including Ethiopia. Objective In this study, the prevalence of smear-positive tuberculosis among presumptive TB cases who visited the hospital was assessed. Method Acid fast bacilli (AFB) test was performed on samples collected from 200 presumptive TB cases. Data were analyzed using appropriate statistical tools. Result Among 200 presumptive TB cases, 10% (20 individuals) (60% were male and 40% were female) were found to be positive for the AFB. Of these AFB positive subjects, 11.2% and 6.3% were from urban and rural areas, respectively. Among 20 AFB positive cases, 45% (9), 45% (9), and 10% (2) were HIV positive, HIV negative, and with HIV status unknown, respectively. The highest AFB positive cases were found within age group between 25 and 44 years (70%) and followed by age above 40 years (30%). It was found out that 75% (15), 15% (3), 5% (1), and 5% (1) were unemployed, government employed, student, and nongovernment employed, accordingly. Conclusion This study indicated higher level of AFB positive cases within age groups of 25–44 and 65–74 years and also exhibited higher prevalence of TB cases from urban areas.

Prevalence of Smear Positive Tuberculosis among Patient Attending, National Hospital Abuja, Federal Capital Territory, Nigeria

Prevalence of Smear Positive Tuberculosis among Patient Attending, National Hospital Abuja, Federal Capital Territory, Nigeria

The first population-based national tuberculosis prevalence survey in Ethiopia, 2010-2011.

Tuberculosis (TB) remains a major public health problem in Ethiopia. To determine the prevalence of pulmonary TB among the general adult population aged ≥15 years in 2010-2011. METHOD A nationwide, cluster-sampled, stratified (urban/rural/pastoralist), cross-sectional survey was conducted in 85 selected clusters. All consenting participants were screened for TB using: 1) chest X-ray (CXR) and 2) an interview to screen for symptoms suggestive of TB disease. Of 51,667 eligible individuals, 46,697 (90%) participated in the survey and completed at least the screening interview. CXR was performed among 46,548 (99.7%) participants. A total of 6080 (13%) participants were eligible for sputum examination. From the survey, it was estimated that in the national adult population 1) the prevalence of smear-positive TB was 108/100,000 (95%CI 73-143), and 2) that of bacteriologically confirmed TB was 277/100,000 (95%CI 208-347). We found that the TB burden was lower than previously thought, which may indicate better programme performance. However, a high proportion of TB among young persons suggests that TB is circulating in the community and that there is a need for more efforts to limit the spread of TB disease.

Smear positive pulmonary tuberculosis and its risk factors among tuberculosis suspect in South East Ethiopia; a hospital based cross-sectional study.

BackgroundTuberculosis remains a deadly infectious disease, affecting millions of people worldwide. Ethiopia ranks seventh among the twenty two high tuberculosis burden countries. The aim of this study was to determine the prevalence of smear positive pulmonary tuberculosis and its associated risk factors in Goba and Robe hospitals of Bale zone.MethodsA cross-sectional study was conducted on tuberculosis suspected patients from February-May 2012. Sputum samples were examined for acid fast bacilli using Ziehl-Neelsen staining and interview was conducted for each patient. Descriptive statistics, binary logistic and multivariable logistic regression analyses were employed to identify factors associated with pulmonary tuberculosis infection.ResultThe prevalence of smear positive tuberculosis was 9.2%. Age >36 (AOR = 3.54, 95% CI = 1. 3–9.82), marital status (AOR = 8.40, 95% CI = 3.02-23.20), family size (AOR = 4. 10, 95% CI = 1.60-10.80), contact with active tuberculosis patient (AOR = 5. 90; 95% CI = 2. 30–15.30), smoking cigarette regularly (AOR = 3. 90; 95% CI = 1. 20–12.40), and human immunodeficiency virus sero-status (AOR = 11. 70; 95% CI = 4. 30–31.70) were significantly associated with smear positive pulmonary tuberculosis.ConclusionThe prevalence of smear positive pulmonary tuberculosis was high in the study area. Age, marital status, family size, history of contact with active tuberculosis patient, smoking cigarettes, and HIV sero-status were among the risk factors significantly associated with acquiring tuberculosis. Hence, strict pulmonary tuberculosis screening of HIV patients and intensification of health education to avoid risk factors identified are recommended.

Prevalence of Smear Positive Tuberculosis, Intestinal Parasites and Their Co-Infection among Tuberculosis Suspects in Gondar University Hospital and Gondar Poly Clinic, North West Ethiopia

Background: The high prevalence of intestinal parasites indicated an increased morbidity in TB patients and emphasized the importance of continued stool analysis and treatment. Reducing the morbidity and mortality of TB and intestinal parasitosis co-infected persons requires an improved understanding of the prevalence of TB, intestinal parasites and their co-infection. Objectives: This study determines the prevalence of Smear positive tuberculosis, intestinal parasites and their co-infection among tuberculosis suspects in Northwest Ethiopia. Methods: A cross sectional study was conducted from March 2008-May 2008 among four hundred and fifteen tuberculosis suspects. Socio-demographic and clinical data was collected using structured questionnaire. Spot morning spot sputum sample were collected for direct AFB microscopy, and stool samples for direct saline microscopy and formol-ether concentration technique. Statistical analysis was performed using SPSS Version 16.0 software packages. Pearson chi-squared test, odds ratio and 95% confidence interval were used to measure the strength of an association. A p-value of <0.05 was considered statistically significant. Results: The mean age the participants were 35.72 years for both sexes. Smear positive tuberculosis and intestinal parasites were diagnosed in 72 (17.3%) & 120 (28.9%) of the study subjects, respectively. Intestinal parasites were detected in 24(33.3%) of smear positive tuberculosis patients. Hookworm and Strongyloides stercolaries infection were common in smear positive tuberculosis patients, with prevalence of 8 (11.1%) and 5(6.9%), respectively. Smear positive TB patients were frequently co-infected with parasitic infection (X2=28.148, p=0.154) that will increase morbidity. Tuberculosis had significant association with shoe wearing (p=0.038) and finger nail (p=0.039). Bacillus Calmat and Guerin vaccination was also strongly associated with pulmonary tuberculosis infection (OR=0.262; 95%CI, 0.126-0.545, p=0.00). Conclusion: The prevalence of smear positive tuberculosis and intestinal parasitosis co-infection predominantly Hookworm is relatively higher among tuberculosis suspects that may increase morbidity, so all tuberculosis suspects should be checked for parasitic infection and be treated accordingly.

Screening for TB in high school adolescents in a high burden setting in South Africa

Screening for tuberculosis (TB) disease is important for TB control and TB vaccine efficacy trials but this has not been evaluated in adolescents. We conducted a study to determine the prevalence of active TB and performance of specific screening tests for TB in adolescents in a high burden setting. Adolescents aged 12-18 years were recruited from high schools in a rural town in South Africa. Participants were screened for active TB using symptoms, household TB contact, positive interferon gamma release assay (IGRA) and positive tuberculin skin test (TST). Of 6363 adolescents recruited, 21 were newly diagnosed with TB of whom 19 were culture positive. After exclusions, the derived prevalence of smear positive TB was 16/5682 = 3/1000 (95% confidence interval (CI) 1-4/1000). The sensitivity of TST and IGRA for active TB were 85% (95% CI 62-100%) and 94% (95% CI 79-100%) respectively. None of the methods alone or in combination had positive predictive values greater than 2%. The screening tools evaluated in this study may not be practical for routine use owing to low positive predictive values but may be useful in TB vaccine clinical trials.

Correlation of ambient pollution levels and heavily-trafficked roadway proximity on the prevalence of smear-positive tuberculosis

Varying levels of evidence exist for the contribution of indoor air pollution and environmental tobacco smoke as a risk factor for tuberculosis (TB). Despite a similar mechanism of action, the influence of outdoor air pollution exposure as an independent contributor to TB disease has yet to be explored. This area of inquiry is of increasing importance given the level of pollution in the rising economies of many TB-endemic nations. Los Angeles' unique physical environs and traffic patterns mirror other global megacities with a greater burden of TB therefore allowing for preliminary correlative studies. This preliminary study hypothesizes that individuals who reside proximal to elevated pollutant exposures are likely to have a greater burden of disease--as evidenced by sputum smear-positive TB. Retrospective medical records review. Medical records of non-homeless individuals (n = 196) diagnosed with culture positive TB at Los Angeles County and University of Southern California Medical Center Hospital were analyzed from January 2007 to December 2008. The study population was grouped according to acid-fast bacilli (AFB) smear-positive (n = 111) and smear-negative (n = 85) status. Air pollutant exposure was captured using measurements of ozone (O3) and particulate matter with an aerodynamic diameter of less than 2.5 (PM2.5). Individual assignment to O3 and PM2.5 exposures were based on residential proximity to the nearest US Environmental Protection Agency's monitoring station. Proximity of home residences to traffic-related pollutants occurred by measurement of distance to the nearest freeway and major non-freeway road. Single factorial models yielded a significant correlation of smear-positive status and residential exposure to PM2.5. Residential distance to freeways and major arterial roads did not yield an association. This is the first report linking ambient pollution exposure as a risk factor for TB. PM2.5 may have the potential to impact TB lung pathology as evidenced by the linkage of fine particulate matter levels and smear-positive TB.

Feasibility, Yield, and Cost of Active Tuberculosis Case Finding Linked to a Mobile HIV Service in Cape Town, South Africa: A Cross-sectional Study

The World Health Organization is currently developing guidelines on screening for tuberculosis disease to inform national screening strategies. This process is complicated by significant gaps in knowledge regarding mass screening. This study aimed to assess feasibility, uptake, yield, treatment outcomes, and costs of adding an active tuberculosis case-finding program to an existing mobile HIV testing service. The study was conducted at a mobile HIV testing service operating in deprived communities in Cape Town, South Africa. All HIV-negative individuals with symptoms suggestive of tuberculosis, and all HIV-positive individuals regardless of symptoms were eligible for participation and referred for sputum induction. Samples were examined by microscopy and culture. Active tuberculosis case finding was conducted on 181 days at 58 different sites. Of the 6,309 adults who accessed the mobile clinic, 1,385 were eligible and 1,130 (81.6%) were enrolled. The prevalence of smear-positive tuberculosis was 2.2% (95% CI 1.1-4.0), 3.3% (95% CI 1.4-6.4), and 0.4% (95% CI 1.4 015-6.4) in HIV-negative individuals, individuals newly diagnosed with HIV, and known HIV, respectively. The corresponding prevalence of culture-positive tuberculosis was 5.3% (95% CI 3.5-7.7), 7.4% (95% CI 4.5-11.5), 4.3% (95% CI 2.3-7.4), respectively. Of the 56 new tuberculosis cases detected, 42 started tuberculosis treatment and 34 (81.0%) completed treatment. The cost of the intervention was US$1,117 per tuberculosis case detected and US$2,458 per tuberculosis case cured. The generalisability of the study is limited to similar settings with comparable levels of deprivation and TB and HIV prevalence. Mobile active tuberculosis case finding in deprived populations with a high burden of HIV and tuberculosis is feasible, has a high uptake, yield, and treatment success. Further work is now required to examine cost-effectiveness and affordability and whether and how the same results may be achieved at scale.

Prevalence of smear-positive tuberculosis in persons aged ⩾15 years in Bangladesh: results from a national survey, 2007–2009

The aim of this study was to determine the nationwide prevalence of smear-positive tuberculosis (TB) in Bangladesh. A multi-stage cluster survey of a random sample of persons aged ≥ 15 years was included in 40 clusters (20 urban, 20 rural). Two sputum samples were collected from study participants and tested initially by fluorescence microscopy and confirmed by the Ziehl-Neelsen method. The crude and adjusted prevalence rates and 95% confidence intervals (CIs) were calculated using standard methods. A total of 33 new smear-positive TB cases were detected among 52 098 individuals who participated in the study. The average participation rate was over 80%. The overall crude prevalence of new smear-positive TB in persons aged ≥ 15 years was estimated as 63.3/100 000 (95% CI 43.6-88.9) and the adjusted prevalence was 79.4/100 000 (95% CI 47.1-133.8). TB prevalence was higher in males (n = 24) and in rural areas (n = 20). The prevalence was highest in the 55-64 years age group (201/100 000) and lowest in 15-24 years age group (43.0/100 000). The prevalence was higher in persons with no education (138.6/100 000, 95% CI 78.4-245.0). The overall prevalence of smear-positive TB was significantly lower than the prevalence estimate of the previous nationwide survey in Bangladesh in 1987-1988 (870/100 000).

Detection of pulmonary tuberculosis among patients with cough attending outpatient departments in Dar Es Salaam, Tanzania: does duration of cough matter?

BackgroundAccording to WHO estimates, tuberculosis case detection rate in Tanzania is less than 50% and this poses a major challenge to control tuberculosis in the country. Currently, one of the defining criteria for suspecting tuberculosis is cough for two weeks or more. We wanted to find out whether the prevalence of tuberculosis was different in patients who reported cough for two weeks or more, compared to patients with cough for less than two weeks.MethodsWe conducted a cross sectional study in six health facilities in Dar es Salaam, between September and October 2007. All patients aged five years and above with cough were screened for pulmonary tuberculosis (PTB) by smear microscopy. Patients were divided into two groups, those who coughed for less than two weeks (<2 wks) and those who coughed for two weeks or more (≥ 2 wks).ResultsA total of 65,530 patients attended outpatients department (OPD). Out of these, 2274 (3.5%) patients reported cough. Among patients who reported cough, 2214 (97.4%) remembered their cough duration. One thousand nine hundred and seventy three patients (89.1%) coughed for ≥ 2 wks as compared to 241 (10.9%) patients who coughed for <2 wks. Of those who coughed for two weeks or more, 250 (12.7%) had smear positive PTB, and of those who had coughed for less than two weeks, 21 (8.7%) had smear positive PTB. There was no statistically significant difference in prevalence of smear positive tuberculosis among the two groups (Pearson Chi-Square 3.2; p = 0.074).ConclusionDetection of smear positive PTB among patients who coughed for less than two weeks was as high as for those who coughed for two weeks or more.

Breaking the law: tuberculosis disobeys Styblo's rule

In 1985 Karel Styblo derived one of the guiding rules of tuberculosis (TB) epidemiology. Bringing together data from 16 countries he proposed that an annual incidence of 50 sputum-smear-positive TB cases in a population of 100 000 generates an annual risk of infection of 1%. This rule of thumb quickly became an established and cherished part of the epidemiological canon because it provided a way to estimate albeit indirectly an important but elusive quantity (disease incidence) from a comparatively simple measurement procedure (risk of infection via tuberculin surveys). Though the rule has never formally been viewed as anything better than approximate its theoretical and practical underpinnings have been steadily eroded by the last two decades of epidemiological change. In this issue of the Bulletin van Leth et al. present yet another analysis suggesting that TB disobeys Styblos rule. The rule can no longer be trusted as a method for estimating TB incidence. To understand why the rule has become inapplicable we need to go back to first principles. Working with the limited data available at the time Styblo deduced that deaths per year incidence per year and prevalence of smear-positive TB were held in the ratio 1:2:4. That is in the pre-drug era a smear-positive TB case remained infectious for an average of 2 years and the case fatality rate was 50%. These observations allowed him to estimate smear-positive incidence from prevalence and mortality data and compare these incidence estimates with the measured risk of infection. (excerpt)

Prevalence of tuberculous infection and incidence of tuberculosis; a re-assessment of the Styblo rule

To evaluate the validity of the fixed mathematical relationship between the annual risk of tuberculous infection (ARTI), the prevalence of smear-positive tuberculosis (TB) and the incidence of smear-positive TB specified as the Styblo rule, which TB control programmes use to estimate the incidence of TB disease at a population level and the case detection rate. Population-based tuberculin surveys and surveys on prevalence of smear-positive TB since 1975 were identified through a literature search. For these surveys, the ratio between the number of tuberculous infections (based on ARTI estimates) and the number of smear-positive TB cases was calculated and compared to the ratio of 8 to 12 tuberculous infections per prevalent smear- positive TB case as part of the Styblo rule. Three countries had national population-based data on both ARTI and prevalence of smear-positive TB for more than one point in time. In China the ratio ranged from 3.4 to 5.8, in the Philippines from 2.6 to 4.4, and in the Republic of Korea, from 3.2 to 4.7. All ratios were markedly lower than the ratio that is part of the Styblo rule. According to recent country data, there are typically fewer than 8 to 12 tuberculous infections per prevalent smear-positive TB case, and it remains unclear whether this ratio varies significantly among countries. The decrease in the ratio compared to the Styblo rule probably relates to improvements in the prompt treatment of TB disease (by national TB programmes). A change in the number of tuberculous infections per prevalent smear-positive TB case in population-based surveys makes the assumed fixed mathematical relationship between ARTI and incidence of smear-positive TB no longer valid.

Prioritising between direct observation of therapy and case-finding interventions for tuberculosis: use of population impact measures

BackgroundPopulation impact measures (PIMs) have been developed as tools to help policy-makers with locally relevant decisions over health risks and benefits. This involves estimating and prioritising potential benefits of interventions in specific populations. Using tuberculosis (TB) in India as an example, we examined the population impact of two interventions: direct observation of therapy and increasing case-finding.MethodsPIMs were calculated using published literature and national data for India, and applied to a notional population of 100 000 people. Data included the incidence or prevalence of smear-positive TB and the relative risk reduction from increasing case finding and the use of direct observation of therapy (applied to the baseline risks over the next year), and the incremental proportion of the population eligible for the proposed interventions.ResultsIn a population of 100 000 people in India, the directly observed component of the Directly Observed Treatment, Short-course (DOTS) programme may prevent 0.188 deaths from TB in the next year compared with 1.79 deaths by increasing TB case finding. The costs of direct observation are (in international dollars) I$5960 and of case finding are I$4839 or I$31702 and I$2703 per life saved respectively.ConclusionIncreasing case-finding for TB will save nearly 10 times more lives than will the use of the directly observed component of DOTS in India, at a smaller cost per life saved. The demonstration of the population impact, using simple and explicit numbers, may be of value to policy-makers as they prioritise interventions for their populations.