ABSTRACT
OBJECTIVE: To analyze critical factors in the diagnosis of pulmonary tuberculosis at both the primary and secondary levels, in the Border Region of Chiapas, Mexico. DESIGN: A crossover study (from March to September, 1994) PARTICIPANTS: Patients with chronic cough (n = 221) who sought care in the Out-patient Department of the only second level care hospital available in the region for the uninsured population. Each subject was interviewed, three sputum specimens were requested and the clinical charts reviewed. MEASUREMENTS AND MAIN RESULTS: Fourty-four patients were found positive for pulmonary TB of which six came to the hospital for initial care. 38 had already been seen in a primary care setting. Of those 38 only two had been diagnosed previously by acid fast smear. At the hospital level, the underdiagnosis of TBP was 9%. CONCLUSIONS: The quality of care with regard to the diagnosis of pulmonary tuberculosis needs to be improved at both the primary and hospital levels. Health workers need to be sensitized to the symptomatology and trained to request sputum smears when indicated. The general population also needs to be educated with regard to pulmonary tuberculosis so as to demand better services.
