Prevalence of respiratory symptoms and cases suspicious for tuberculosis among public health clinic patients in Afghanistan, 2005-2006: Perspectives on recognition and referral of tuberculosis cases

To assess diagnosis and management of suspected pulmonary tuberculosis (TB) among patients with respiratory complaints attending Comprehensive Health Centers (CHCs) in Afghanistan. Consecutive consenting patients presenting with respiratory complaints at 24 health centres in eight provinces were enrolled between November 2005 and February 2006. Demographics, health histories, clinic provider and study representative exam findings and diagnoses, and diagnostic test results were recorded. Correlates of TB-suggestive symptoms (defined as cough >2 weeks and/or haemoptysis) were assessed by logistic regression. There were 1401 participants; 24.6% (n = 345) were children (age 17 or under). The TB-suggestive symptoms of cough >2 weeks and/or haemoptysis were reported by 407 (31.3%) and 44(3.3%), respectively, with 39 participants reporting both symptoms. Of 413 participants reporting TB-suggestive symptoms, only 178 (43%) were diagnosed as having suspected TB; 22.0% received no clinical diagnosis. Suspected TB was significantly associated with having a household member residing in a refugee camp within the last 2 years (OR = 6.0; 95% CI: 4.1-8.7), seven or more people sleeping in the same room (OR = 1.9; 95% CI: 1.4-2.6) and cooking with a wood fire in the sleeping room (OR = 1.6; 95% CI: 1.2-2.2) in univariate analysis. Diagnostic sensitivity by the health worker for possible cases of pulmonary TB was low, as 22% of persons with suspected tuberculosis received no diagnosis. Further, some common/chronic respiratory ailments were under-diagnosed. There is great need for improved practical training and continuing education in pulmonary disease diagnosis for clinical health workers.