A descriptive study of TB cases finding practices in the three largest public general hospitals in Vietnam

BMC Public Health

Knut Lönnroth¹  Vu Le Thuong²  Cuong Le Xuan⁴  Hanh Chu Thi³  Cornelia Hennig⁵  Khanh Pham Huyen⁵  Hoa Nguyen Binh⁶ 

[1] Stop TB Department, WHO, HQ, Geneva, Switzerland;Cho ray hospital, Ho Chi Minh City, Vietnam;Bach mai hospital, Hanoi, Vietnam;National Hue hospital, Hue, Vietnam;World Health Organization (WHO), VietNam Country Office, Hanoi, Vietnam;National Tuberculosis Programme Vietnam, Hanoi, Vietnam

关键词: Hospital;    Diagnosis;    Screening;    General hospital;    Public-public mix;    Tuberculosis;    Vietnam;   

Others  :  1163055
DOI  :  10.1186/1471-2458-12-808

 received in 2012-06-27, accepted in 2012-09-18,  发布年份 2012

【 摘 要 】

Background

A project was implemented in 2010 to improve TB notification and TB screening and diagnostic routines in large general hospitals. The aims of present study was to assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam.

Objectives

To assess baseline TB screening and diagnostic practices in the three largest general hospitals in Vietnam.

Method

The study had three elements: 1) Focus group discussions with hospital physicians; 2) review of hospital records and structured interviews of people who had a chest X-ray on any indication; and 3) record reviews and structured interviews of people newly diagnosed with TB.

Results

The most commonly reported diagnostic pathway for pulmonary TB was chest X-ray followed by sputum-smear microscopy. Among 599 individuals who had a chest X-ray performed, 391 (65.1%) had recorded any abnormality, significantly higher in males (73.8%) than in females (54.7%), (p < 0.001), and the proportion was increasing with age (p <0.001). Among those with abnormal chest X-ray, 245 (69.2%) were investigated with sputum smear microscopy, and 49 (20%) were diagnosed with TB, of which 33 (13.5%) were smear-positive.

Of 103 consecutive TB cases enrolled in the study, 92 (90%) had chest X-ray as the initial test. Sixty-three (61.2%) fulfilled the TB suspect criteria based on respiratory symptoms (productive cough >2 weeks).

Conclusion

Chest X-ray is the preferred first test for TB in the largest hospitals in Vietnam. Chest X-ray is a sensitive screening tool for TB, which should be followed by a confirmatory TB test. While the majority of those with chest X-ray abnormalities are investigated with smear-microscopy, the high sputum-smear positivity ratio among them suggests that sputum-smear microscopy is done mainly for persons with quite clear TB signs or symptoms. TB screening and use of confirmatory diagnostic tests on wider indications seem warranted.

【 授权许可】

   
2012 Nguyen Binh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

【 参考文献 】

• [1]World Health Organization: Global tuberculosis control 2011. 2011, 1-246. [World Health Organization Document 2011] WHO/HTM/TB/2011.16
• [2]Huong NT, Duong BD, Co NV, Quy HT, Tung LB, Bosman M, et al.: Establishment and development of the National Tuberculosis Control Programme in Vietnam. Int J Tuberc Lung Dis 2005, 9:151-156.
• [3]Hoa NB, Sy DN, Nhung NV, Tiermersma EW, Borgdorff MW, Cobelens FGJ: National survey of tuberculosis prevalence in VietNam. Bull World Health Organ 2010, 88:273-280.
• [4]Hoa NB, Cobelens FGJ, Sy DN, Nhung NV, Borgdorff MW, Tiermsma EW: Diagnosis and treatment of tuberculosis in the private sector, Vietnam. (Correspondence). Emerg Infect Dis 2011, 17:562-564.
• [5]Quy HT, Lan NTN, Lönnroth K, Buu TN, Dieu TTN, Hai LT: Public-private mix for improved TB control in Ho Chi Minh City, Vietnam: an assessment of its impact on case detection. Int J Tuberc Lung Dis 2003, 7:464-471.
• [6]National Center for Tuberculosis and Leprosy Control: National TB prevalence survey, 2002 Cambodia. 1–77. Ministry of Health, Phnom Penh; 2005. Ref Type: Report
• [7]World Health Organization: Rapid implementation of the Xpert MTB/RIF diagnostic test. Technical and operational ‘How to’ practical considerations. 2011, 1-34. [World Health Organization Document 2011] WHO/HTM/TB/2011.2
• [8]Boehme CC, Nicol MP, Nabeta P, Michael JS, Gotuzzo E, Tahirli R, et al.: Feasibility, diagnostic accuracy, and effectiveness of decentralised use of the Xpert MTB/RIF test for diagnosis of tuberculosis and multidrug resistance: a multicentre implementation study. Lancet 2011, 377:1495-1505.
• [9]World Health Organization: Tuberculosis prevalence surveys: a handbook. 2011, 1-305. [World Health Organization Document 2010] WHO/HTM/TB/2010.17
• [10]Den Boon S, White NW, van Lill SWP, Borgdorff MW, Verver S, Lombard CJ, et al.: An evaluation of symptom and chest radiographic screening in tuberculosis prevalence surveys. Int J Tuberc Lung Dis 2006, 10:876-882.
• [11]Toman K: Toman’s tuberculosis. Case detection, treatment, and monitoring. Questions and answers, 2 edn. World Health Organization, Geneva; 2004.
• [12]van Cleeff MRA, Kivihya-Ndugga LE, Meme H, Odhiambo JA, Klatser PR: The role and performance of chest X-ray for the diagnosis of tuberculosis: a cost-effectiveness analysis in Nairobi, Kenya. BMC Infect Dis 2005, 5:111. BioMed Central Full Text
• [13]Vassall A, van Kampen S, Sohn H, Michael JS, John KR, Den Boon S, et al.: Rapid diagnosis of tuberculosis with the Xpert MTB/RIF assay in high burden countries: a cost-effectiveness analysis. PLoS Med 2011, 8(11):e1001120.
• [14]Malbruny B, Le Marrec G, Courageux K, Leclerca R, Cattoir V: Rapid and efficient detection of Mycobacterium tuberculosis in respiratory and non-respiratory samples. Int J Tuberc Lung Dis 2011, 15:553-555.