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

Zachariah, R., Spielmann, M. R., Harries, A. D., Gomani, R., Graham, Stephen, Bakali, E. and Humblet, R. (2003) 'Passive versus active tuberculosis case finding and isoniazid preventive therapy among household contacts in a rural district of Malawi'. International Journal of Tuberculosis and Lung Disease, Vol 7, Issue 11, pp. 1033-1039.

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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.

Item Type:	Article
Uncontrolled Keywords:	tuberculosis; case finding; isoniazid; HIV; Malawi
Subjects:	WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications WF Respiratory System > Tuberculosis > WF 300 Pulmonary tuberculosis WS Pediatrics > Diseases of Children and Adolescents > By System > WS 280 Respiratory system
Depositing User:	Ms Julia Martin
Date Deposited:	18 May 2012 10:35
Last Modified:	23 Nov 2018 15:19
URI:	https://archive.lstmed.ac.uk/id/eprint/2707

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