A breakthrough for the quality assurance of chest radiography with a simple assessment tool / 国際保健医療

The human immunodeficiency virus (HIV) epidemic and dual infection of tuberculosis (TB) and HIV are now altering the role of chest radiography (CR) in TB control. The role has been gaining increasing importance, especially as HIV-associated TB and childhood TB are less likely to show positive smears. However, CR with poor image quality can cause misdiagnoses or require repeated examinations, wasting economic resources and exposing patients to unnecessary radiation. In order to improve the image quality of CR, the Tuberculosis Coalition for Technical Assistance (TBCTA) developed an assessment tool for CR categorized on the basis of six factors as “excellent,” “good,” “fair,” and “poor.” With the aim of disseminating the assessment tool, five-day international training sessions were held in Cambodia and Kenya in 2009. This field report summarizes the international training activities and documents the findings after the trainings.<BR>A total of thirty-four participants from 14 countries were trained and assigned to conduct an assessment upon their return. The results from nine countries showed that the quality of CR ranged from 90% excellent or good in Bangladesh to over 90% fair or poor in Afghanistan. Of 69 health facilities, only 4 apply more than 120kV and above. This is one of the considerable factors behind the sub-optimal quality of CR in these countries.

A double-blind study of oral salbutamol supplement and repeat sputum smear microscopy in enhancing diagnosis of smear-negative pulmonary tuberculosis in south India.

Background: As routine culture facilities are not available in TB control programme in low income countries like India, there is an urgent need to improve the sensitivity of sputum microscopy, especially in diagnosis of smear negative pulmonary TB. Methodology: In a double blind placebo controlled study, the role of repeat sputum microscopy after antibiotics and oral salbutamol supplement in improving the diagnosis of smear negative TB suspects was investigated in an urban TB clinic. We undertook culture examinations for all study patients to find out proportions of TB cases in this series. Results: Of 206 enrolled, (101 salbutamol (S), 105 placebo (P) groups) 26 were positive by repeat sputum smear examination; similar in two groups (S 16, P 10, p = 0.25). In all, 40 (S 23, P 17) including 26 smear- positives, were culture -positive for M. tuberculosis. Conclusions: Two thirds of initially smear negative but culture positive TB patients were smear positive on repeat sputum examination. Thus, repeat sputum smear microscopy for TB suspects improved the diagnosis, nevertheless oral salbutamol therapy was not beneficial. In resource poor settings, repeat sputum smear microscopy after a trial of antibiotics, could significantly improve the diagnosis of smear-negative PTB patients.