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Int J Tuberc Lung Dis. 2003 Nov;7(11):1033-9.

Passive versus active tuberculosis case finding and isoniazid preventive therapy among household contacts in a rural district of Malawi.

Author information

1
Operational Research (HIV/TB), Medical Department, Médecins sans Frontières-Brussels Operational Centre, Brussels, Belgium. zachariah@internet.lu

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.

PMID:
14598961
[Indexed for MEDLINE]
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