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


Zachariah, R; Spielmann, MP; Harries, AD; Gomani, P; Graham, SM; Bakali, E; Humblet, P; (2003) Passive versus active tuberculosis case finding and isoniazid preventive therapy among household contacts in a rural district of Malawi. The international journal of tuberculosis and lung disease, 7 (11). pp. 1033-9. ISSN 1027-3719

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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
Keywords: Adolescent, Adult, Aged, Antitubercular Agents, Child, Preschool, Comorbidity, Contact Tracing, Cross-Sectional Studies, Female, HIV Infections, Humans, Isoniazid, Malawi, Male, Middle Aged, Rural Population, Tuberculosis, Pulmonary, Adolescent, Adult, Aged, Antitubercular Agents, therapeutic use, Child, Preschool, Comorbidity, Contact Tracing, methods, Cross-Sectional Studies, Female, HIV Infections, epidemiology, Humans, Isoniazid, therapeutic use, Malawi, epidemiology, Male, Middle Aged, Rural Population, Tuberculosis, Pulmonary, epidemiology, prevention & control, radiography
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 14598961
Web of Science ID: 186222600004
URI: http://researchonline.lshtm.ac.uk/id/eprint/8923

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