STUDY OF CASE-FINDING FOR PULMONARY TUBERCULOSIS IN OUTPATIENTS COMPLAINING OF A CHRONIC COUGH AT A DISTRICT HOSPITAL IN KENYA

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Abstract
This investigation is the fifth in a series of case-finding studies in Kenya. It explores the potential for case-finding by the identification of persons with suspected tuberculosis (persons with a cough for .gtoreq. 1 mo.) through careful screening of general outpatients attending a district hospital. Of 601 suspects identified among 20,756 new outpatients attending hospital during a period of 11 wk, 5.6% were considered by an independent assessor to have active pulmonary tuberculosis (2.2% with sputum positive on both smear and culture, 1.2% on culture only and 2.2% negative sputum but radiographically active lesions). A further 2.0% were considered to have inactive tuberculosis. This method of case-finding appears to be uniformly effective within a radius of .apprx. 9 miles of the hospital, becoming less effective outside this range. There were certain important diagnostic pointers. There was an excess of tuberculosis cases in males, in those with weight loss, in those with a history of cough of < 1 yr, in those with a history of hemoptysis, and in those .gtoreq. 35 yr old. This investigation provides additional support to previous studies, which demonstrated serious problems of case-finding in the peripheral health units and suggests that unless the infrastructure of primary health care at the periphery can be improved, the policy should be to diagnose tuberculosis in the district hospital and to operate a simple referral system for persons with suspected tuberculosis from the periphery.