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Screening pulmonary tuberculosis suspects in Malawi: testing different strategies
A D Harries1, A Kamenya, V R Subramanyam
1Department of Medicine, College of Medicine, Blantyre, Malawi, Central Africa.
Summary
Screening tuberculosis suspects in Malawi using sputum smear microscopy is more effective and cost-efficient than chest radiography. This approach improves tuberculosis diagnosis in sub-Saharan Africa.
Area of Science:
- Public Health
- Infectious Diseases
- Diagnostic Strategies
Background:
- Sub-Saharan Africa faces challenges in tuberculosis (TB) screening.
- Alternative strategies are needed for diagnosing TB suspects.
Purpose of the Study:
- To compare the diagnostic efficacy and cost-effectiveness of two TB screening strategies.
- To evaluate sputum smear microscopy versus chest radiography for TB diagnosis.
Main Methods:
- Assessed ambulatory adult TB suspects at Queen Elizabeth Central Hospital, Malawi.
- Compared strategy A (sputum smear microscopy then CXR) with strategy B (CXR then sputum smear microscopy).
- Analyzed diagnostic yield and cost per diagnosed case.
Main Results:
- Strategy A diagnosed 60% of pulmonary TB (PTB) cases with a cost of US$4.63 per case.
- Strategy B diagnosed 57% of PTB cases with a cost of US$5.44 per case.
- Sputum smear microscopy screening was more effective and less costly than CXR screening.
Conclusions:
- Screening TB suspects using sputum smear microscopy is superior to CXR.
- Effective TB screening criteria enhance diagnostic sensitivity.
- Sputum smear microscopy offers a more cost-effective approach for TB diagnosis in this setting.