The execution rate of procedures to diagnose extrapulmonary tuberculosis in Botswana

Background: Extra-pulmonary tuberculosis (EPTB) accounts for about 20% of TB cases worldwide. Its diagnosis is challenging. Aim: This study meant to assess the prevalence of EPTB types, procedures to diagnose EPTB and medical officers' (MOs) views on procedures performed in the diagnosis of EPTB over a 2-year period in Botswana. Setting: The study was conducted in 13 urban and rural facilities of 29 health districts in Botswana. Methods: This was a cross-sectional study that reviewed patients' TB data and administered a questionnaire to MOs. Results: About 2 in 10 TB (n= 2996, 22.7%) cases were classified as EPTB. The most common site of EPTB was pleural (n= 1066, 36.7%) followed by lymph node (LN) (n= 546, 18.8%). A pleural tap was performed in 182 (17.0%) cases of pleural TB and a fine needle aspiration (FNA) in one-third (n= 160, 29.6%) of LN TB cases. There were statistical differences in work experience amongst MOs' responses regarding their self-reported confidence to undertake basic procedures to diagnose EPTB such as pleural tap (p= 0.032) or FNA (p< 0.0001). Conclusion: This study reviewed and evaluated the proportion of EPTB and inquired about MO's experience in managing EPTB. Despite MOs' attendance at Botswana National Tuberculosis Programme (BNTP) TB case management (TBCM) training, the emphasis by the BNTP guidelines and availability of logistics, the execution rate of procedures to diagnose EPTB was still low in Botswana

Spontaneous sputum examination for early diagnosis of pneumocystis carinii in Ugandan AIDS patients

Whereas Pneumocystis carinii pneumonia (PCP) is one of the major complications and causes of death in patients with the Acquired Immunodeficiency Syndrome (AIDS); patients show that mycobacterium tuberculosis (MTB) is a commoner cause of HIV-associated pneumonia than PCP. Most methods used to diagnose PCP entail invasive and expensive techniques which are beyond the facilities available in developing countries. This study; was therefore designed to evaluate spontaneous sputum examination as a cheaper method for the diagnosis of PCP. Sputum specimens collected in 1987 from 54 AIDS Patients in Mulago Hospital were stained using a modified Gram stain and read by a competent technician. None of the 54 slides contained evidence of P.carinii. These results were consistent with other studies in Africa which show that PCP is rare among AIDS patients. However; because of lack of other definitive diagnostic evidence for the presence or absence of PCP; it was not possible to conclusively assess the usefulness of spontaneous sputum examination. Further studies are needed to determine the presence or absence of PCP among AIDS patients in Africa; and to evaluate cheaper and invasive diagnostic tools for developing countries