The sensitivity of the tuberculosis verbal screening tool for the prisoners in Uttaradit jail

Abstract

        The objective of this research is to study sensitivity of the tuberculosis verbal screening tool which is recommended by Bureau of Tuberculosis, Department of Disease Control, Ministry of Public health, Thailand. Population in the study include all of 856 prisoners in Uttaradit jail during 10 - 1 I July 2009. The verbal survey for tuberculosis by interview follow the reccomended screening tool. The diagnosis of tuberculosis were done by chest X-rays, AFB sputum examination by microscope and sputum culture for tuberculosis bacillus.

           The Findings: The majority of Uttaradit prisoners (74.8 percent) had no symptom. The results of chest X-rays showed 41 cases of abnormal infiltration (4.8 percent of all). The results of AFB Sputum examination by microscope and sputum culture for tuberculosis bacillus found 15 cases of sputum positive for tuberculosis (1.75 percent). 6 cases were identified as active pulmonary tuberculosis (0.70 percent) and 9 cases were indentified as inactive pulmonary tuberculosis (1.05 percent). Among pulmonary tuberculosis cases, 12 cases (80.0 percent) had no symptom of pulmonary tuberculosis and 3 cases (20.0 percent) had only 1 criteria. The sensitivity of the screening tool for Uttaradit prisoners who had positive findings by chest X-rays (suggestive pulmonary tuberculosis) showed that one of the symptom or more of the screening tool had sensitivity of 36.6. The symptom of coughing more than 2 weeks, coughing up blood, fever more than 2 weeks and weight loss 3-5 kilograms per month showed had sensitivity of 14.6, 4.9, 9.8 and 2.4 respectively. The symptom of sweats at night showed zero sensitivity for chest X-rays in Uttaradit prisoners. The symptom of one or more of the screening tool , coughing more than 2 weeks , coughing up blood, fever more than 2 weeks had relation to positive chest X-rays significantly (p-value <0.05).The symptom of sweats at night and weight loss 3-5 kilograms per month has no relation to positive chest X-rays.

           The suggestion of screening test to identify the suspected cases from population and refer to doctor for definite diagnosis and proper treatment must has high sensitivity. The findings of this study found that the 5 verbal screening clauses recommended by Bureau of Tuberculosis had low sensitivity which would miss many pulmonary tuberculosis patients. Crowded and poor ventilation in prison cause high chance of tuberculosis spreading. Death from delay treatment could occur in severe cases of tuberculosis .Current verbal screening tool is not sensitive enough for tuberculosis therefore chest X-rays is suggested to perform for all. There is a need to develop a more sensitive verbal screening tool to be used in high prevalent area such as prison.