The detection of active pulmonary tuberculosis in Singapore

A prospective study was carried out to identify the services which were responsible for detection of pulmonary tuberculosis in Singapore. It was found that the public health services were the sources of 58.8% of cases. Among them the Tuberculosis Control Department detected the largest proportion (25.8%) of cases. These formed the majority of the asymptomatic and a large proportion of the abacillary cases detected. It was suggested that this reflected the result of the Department's active case-finding programme. The private practitioners identified 30% of patients. More than half of them were bacillary cases and they were a significant proportion of all infectious cases detected. Thus while the Department of Tuberculosis Control detected most of the patients with early tuberculosis disease, the bulk of the infectious cases with extensive disease were diagnosed by the private practitioners. Both sectors complement each other in the detection of tuberculosis cases in the country. An improvement and expansion of the existing case detection programme among patients attending the clinics of private practitioners and the Outpatient Service Department's dispensaries was recommended. The way in which this could be done and some of the problems that might be encountered were discussed.