Passive Versus Active Tuberculosis Case Finding and Isoniazid Preventive Therapy Among Household Contacts in a Rural District of Malawi.

Hdl Handle:
http://hdl.handle.net/10144/17741
Title:
Passive Versus Active Tuberculosis Case Finding and Isoniazid Preventive Therapy Among Household Contacts in a Rural District of Malawi.
Authors:
Zachariah, R; Spielmann M P; Harries, A D; Gomani, P; Graham, S; Bakali, E; Humblet, P
Journal:
The International Journal of Tuberculosis and Lung Disease : the official journal of the International Union against Tuberculosis and Lung Disease
Abstract:
SETTING: Thyolo district, rural Malawi. OBJECTIVES: To compare passive with active case finding among household contacts of smear-positive pulmonary tuberculosis (TB) patients for 1) TB case detection and 2) the proportion of child contacts aged under 6 years who are placed on isoniazid (INH) preventive therapy. DESIGN: Cross-sectional study. METHODS: Passive and active case finding was conducted among household contacts, and the uptake of INH preventive therapy in children was assessed. RESULTS: There were 189 index TB cases and 985 household contacts. Human immunodeficiency virus (HIV) prevalence among index cases was 69%. Prevalence of TB by passive case finding among 524 household contacts was 0.19% (191/100000), which was significantly lower than with active finding among 461 contacts (1.74%, 1735/100000, P = 0.01). Of 126 children in the passive cohort, 22 (17%) received INH, while in the active cohort 25 (22%) of 113 children received the drug. Transport costs associated with chest X-ray (CXR) screening were the major reason for low INH uptake. CONCLUSIONS: Where the majority of TB patients are HIV-positive, active case finding among household contacts yields nine times more TB cases and is an opportunity for reducing TB morbidity and mortality. The need for a CXR is an obstacle to the uptake of INH prophylaxis.
Affiliation:
Operational Research (HIV/TB), Medical Department, Médecins sans Frontières-Brussels Operational Centre, Brussels, Belgium. zachariah@internet.lu
Publisher:
International Union Against TB and Lung Disease
Issue Date:
Nov-2003
URI:
http://hdl.handle.net/10144/17741
PubMed ID:
14598961
Additional Links:
http://www.ingentaconnect.com/content/iuatld/ijtld
Language:
en
ISSN:
1027-3719
Appears in Collections:
TB

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, R-
dc.contributor.authorSpielmann M P-
dc.contributor.authorHarries, A D-
dc.contributor.authorGomani, P-
dc.contributor.authorGraham, S-
dc.contributor.authorBakali, E-
dc.contributor.authorHumblet, P-
dc.date.accessioned2008-02-07T16:47:15Z-
dc.date.available2008-02-07T16:47:15Z-
dc.date.issued2003-11-
dc.identifier.citationPassive Versus Active Tuberculosis Case Finding and Isoniazid Preventive Therapy Among Household Contacts in a Rural District of Malawi. 2003, 7 (11):1033-9 Int. J. Tuberc. Lung Dis.en
dc.identifier.issn1027-3719-
dc.identifier.pmid14598961-
dc.identifier.urihttp://hdl.handle.net/10144/17741-
dc.description.abstractSETTING: Thyolo district, rural Malawi. OBJECTIVES: To compare passive with active case finding among household contacts of smear-positive pulmonary tuberculosis (TB) patients for 1) TB case detection and 2) the proportion of child contacts aged under 6 years who are placed on isoniazid (INH) preventive therapy. DESIGN: Cross-sectional study. METHODS: Passive and active case finding was conducted among household contacts, and the uptake of INH preventive therapy in children was assessed. RESULTS: There were 189 index TB cases and 985 household contacts. Human immunodeficiency virus (HIV) prevalence among index cases was 69%. Prevalence of TB by passive case finding among 524 household contacts was 0.19% (191/100000), which was significantly lower than with active finding among 461 contacts (1.74%, 1735/100000, P = 0.01). Of 126 children in the passive cohort, 22 (17%) received INH, while in the active cohort 25 (22%) of 113 children received the drug. Transport costs associated with chest X-ray (CXR) screening were the major reason for low INH uptake. CONCLUSIONS: Where the majority of TB patients are HIV-positive, active case finding among household contacts yields nine times more TB cases and is an opportunity for reducing TB morbidity and mortality. The need for a CXR is an obstacle to the uptake of INH prophylaxis.en
dc.language.isoenen
dc.publisherInternational Union Against TB and Lung Disease-
dc.relation.urlhttp://www.ingentaconnect.com/content/iuatld/ijtld-
dc.rightsArchived on this site with the kind permission of the International Union Against TB and Lung Disease, http://www.iuatld.orgen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAntitubercular Agentsen
dc.subject.meshChild, Preschoolen
dc.subject.meshComorbidityen
dc.subject.meshContact Tracingen
dc.subject.meshCross-Sectional Studiesen
dc.subject.meshFemaleen
dc.subject.meshHIV Infectionsen
dc.subject.meshHumansen
dc.subject.meshIsoniaziden
dc.subject.meshMalawien
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshRural Populationen
dc.subject.meshTuberculosis, Pulmonaryen
dc.titlePassive Versus Active Tuberculosis Case Finding and Isoniazid Preventive Therapy Among Household Contacts in a Rural District of Malawi.en
dc.contributor.departmentOperational Research (HIV/TB), Medical Department, Médecins sans Frontières-Brussels Operational Centre, Brussels, Belgium. zachariah@internet.luen
dc.identifier.journalThe International Journal of Tuberculosis and Lung Disease : the official journal of the International Union against Tuberculosis and Lung Diseaseen

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