World Health Organization and Revised National Tuberculosis Control Program (RNTCP) of India recommends 3 sputum smear examinations(Day-1:1st spot,Day-2:Early morning specimen +2nd spot) for diagnosis of pulmonary tuberculosis in patients having cough of 3 weeks or more.To evaluate the performance of RNTCP for diagnostic activities,a study to find out any gap between recommended guidelines and actual performance under program conditions need to be carried out.
A retrospective study of 3916 patients attending TB & Chest Hospital Patiala who were advised sputum smear examination was undertaken.A note was made of gender,number of sputum specimens examined and result of sputum examination. Findings were analyzed.
Out of 3916 chest symptomatics,2221(56.71%) were males and 1695(43.28%) were females.Out of these 3916 patients,1354(34.5%) patients did not undergo requisite specimen examinations. 685(50.59%), 657(48.52%) and 22(1.62%) patients missed one, two and three specimens examinations respectively. Sputum examination on Day-1 was positive in 256(88.58%) males and 145(43.67%) females out of a total 289 males and 332 females respectively.
One out of three patients did not undergo 3 requisite smear examinations. Although more females (19.58%) were having sputum positive than males (13.01%) but on Day-1, more number of males (88.58%) as compared to females (43.67%) were positive. Females may be feeling more comfortable at home for producing sputum for smear examination. Single day sputum smear examination cannot be recommended because only 401(64.57%) patients out of a total of 621 sputum positive patients were positive on Day-1.
Since 34.5% patients didnot undergo 3 requisite sputum smear examinations, a foolproof methodology need to be implemented to trace the patients who miss the requisite number of smear examinations. All patients especially females should be told the importance of examination of 3 specimens. Patients should be demonstrated the correct technique of producing sputum specimen. Sputum specimen should be collected under supervision. A separate enclosure can be useful for producing sputum specimen to avoid hesitancy in front of onlookers.
J. Kishan, None.