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Comparing the Yield of Frontloading Microscopy Examination with Conventional Sputum Microscopy Examination for the Diagnosis of Tuberculosis in Tanzania
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A5550 - Comparing the Yield of Frontloading Microscopy Examination with Conventional Sputum Microscopy Examination for the Diagnosis of Tuberculosis in Tanzania
Author Block: G. D. Kimaro1, B. B. Kilowoko2, O. C. Millanzi2, S. R. Temu2, E. S. Ngadaya1, E. H. Sandi1, R. Shemtandulo1, S. G. Mfinanga1; 1National Institute for Medical Research, Dar Es Salaam, Tanzania, United Republic of, 2St. Benedict’s Ndanda Referral Hospital, Mtwara, Tanzania, United Republic of.
Rationale: In the resources limited countries, a TB suspect is required to submit two sputum (spot and morning) samples for diagnosis. This diagnosis pathway may lead to pre-treatment loses from care, because some may submit only spot sputum samples or may submit both spot and morning sputum samples but don’t come back for their results. Some of the defaulters may be smear positive posing two dangers - spreading disease to the community and secondly, the defaulter suffers TB related morbidity and mortality. Our local experience from one of hospital in Tanzania i.e the St. Benedict’s Ndanda Referral Hospital (BNRH) shows that during the last three quarters of 2014, a total of 689 TB suspects were registered at the facility. Half of these suspects did not submit their morning sputum sample, hence their TB status was not completely established. These pre-treatment loses from care could be curbed if diagnosis pathway could be completed on the same day. We introduced and examined the yield of a front - loading (submitting two spot sputum samples on the same day) TB diagnosis approach and compare it with the yield of the conventional approach (spot-morning sputum submission).
Methodology: All TB suspects who presented at BNRH between 10th .November 2015 and 4th July 2016 were asked to submit the usual two (spot and morning) sputum samples and an additional spot sputum specimen (Xspot) an hour after the first spot sputum sample. Sputum samples were processed using both Ziehl-Neelsen stain (ZN) and GeneXpert.
Results. All 473 TB suspects enrolled in the study submitted spot 1 sputum samples, 470 (99.4%) submitted Xpot sample and 374 (79.1%) submitted morning sample. Nineteen percent of the participants who submitted spot 1 samples tested ZN positive. Nineteen percent (89/470) of those who submitted Xspot sample tested ZN positive. All these 89 also tested ZN positive on spot 1. Twenty percent (74/374) of those who submitted morning sputum samples tested ZN positive and their results were similar to those of spot 1 and Xspot. Additional, GeneXpert tests were performed to 180 (38%) spot 1 samples, and 42(23.3%) of them tested GenXpert positive and were also ZN positive on spot 1 and Xspot. Combination of ZN results for spot 1 and Xspot yields similar ZN results as those of combining ZN results for spot 1 and morning samples.
Conclusion. Frontloading approach yields similar results as conventional approach.
Author Block: G. D. Kimaro1, B. B. Kilowoko2, O. C. Millanzi2, S. R. Temu2, E. S. Ngadaya1, E. H. Sandi1, R. Shemtandulo1, S. G. Mfinanga1; 1National Institute for Medical Research, Dar Es Salaam, Tanzania, United Republic of, 2St. Benedict’s Ndanda Referral Hospital, Mtwara, Tanzania, United Republic of.
Rationale: In the resources limited countries, a TB suspect is required to submit two sputum (spot and morning) samples for diagnosis. This diagnosis pathway may lead to pre-treatment loses from care, because some may submit only spot sputum samples or may submit both spot and morning sputum samples but don’t come back for their results. Some of the defaulters may be smear positive posing two dangers - spreading disease to the community and secondly, the defaulter suffers TB related morbidity and mortality. Our local experience from one of hospital in Tanzania i.e the St. Benedict’s Ndanda Referral Hospital (BNRH) shows that during the last three quarters of 2014, a total of 689 TB suspects were registered at the facility. Half of these suspects did not submit their morning sputum sample, hence their TB status was not completely established. These pre-treatment loses from care could be curbed if diagnosis pathway could be completed on the same day. We introduced and examined the yield of a front - loading (submitting two spot sputum samples on the same day) TB diagnosis approach and compare it with the yield of the conventional approach (spot-morning sputum submission).
Methodology: All TB suspects who presented at BNRH between 10th .November 2015 and 4th July 2016 were asked to submit the usual two (spot and morning) sputum samples and an additional spot sputum specimen (Xspot) an hour after the first spot sputum sample. Sputum samples were processed using both Ziehl-Neelsen stain (ZN) and GeneXpert.
Results. All 473 TB suspects enrolled in the study submitted spot 1 sputum samples, 470 (99.4%) submitted Xpot sample and 374 (79.1%) submitted morning sample. Nineteen percent of the participants who submitted spot 1 samples tested ZN positive. Nineteen percent (89/470) of those who submitted Xspot sample tested ZN positive. All these 89 also tested ZN positive on spot 1. Twenty percent (74/374) of those who submitted morning sputum samples tested ZN positive and their results were similar to those of spot 1 and Xspot. Additional, GeneXpert tests were performed to 180 (38%) spot 1 samples, and 42(23.3%) of them tested GenXpert positive and were also ZN positive on spot 1 and Xspot. Combination of ZN results for spot 1 and Xspot yields similar ZN results as those of combining ZN results for spot 1 and morning samples.
Conclusion. Frontloading approach yields similar results as conventional approach.
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