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BMC Public Health. 2012; 12: 132.
Published online Feb 15, 2012. doi:  10.1186/1471-2458-12-132
PMCID: PMC3338364
Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia
Riris Andono Ahmad,corresponding author#1,2 Francine Matthys,#3 Bintari Dwihardiani,1 Ning Rintiswati,4 Sake J de Vlas,2 Yodi Mahendradhata,1,3 and Patrick van der Stuyft3
1Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia
2Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
3Unit of Epidemiology & Disease Control, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
4Department of Microbiology, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia
corresponding authorCorresponding author.
#Contributed equally.
Riris Andono Ahmad: risandono.ahmad/at/gmail.com; Francine Matthys: fmatthys/at/itg.be; Bintari Dwihardiani: bintari_dwihardiani/at/yahoo.com; Ning Rintiswati: rintiswati/at/gmail.com; Sake J de Vlas: s.devlas/at/erasmusmc.nl; Yodi Mahendradhata: yodi_mahendradhata/at/yahoo.co.uk; Patrick van der Stuyft: pvdstuyft/at/itg.be
Received August 29, 2011; Accepted February 15, 2012.
Abstract
Background
Early and accurate diagnosis of pulmonary tuberculosis (TB) is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO) recommends the use of a diagnostic algorithm. Our study evaluated the implementation of the national tuberculosis programme's diagnostic algorithm in routine health care settings in Jogjakarta, Indonesia. The diagnostic algorithm is based on the WHO TB diagnostic algorithm, which had already been implemented in the health facilities.
Methods
We prospectively documented the diagnostic work-up of all new tuberculosis suspects until a diagnosis was reached. We used clinical audit forms to record each step chronologically. Data on the patient's gender, age, symptoms, examinations (types, dates, and results), and final diagnosis were collected.
Results
Information was recorded for 754 TB suspects; 43.5% of whom were lost during the diagnostic work-up in health centres, 0% in lung clinics. Among the TB suspects who completed diagnostic work-ups, 51.1% and 100.0% were diagnosed without following the national TB diagnostic algorithm in health centres and lung clinics, respectively. However, the work-up in the health centres and lung clinics generally conformed to international standards for tuberculosis care (ISTC). Diagnostic delays were significantly longer in health centres compared to lung clinics.
Conclusions
The high rate of patients lost in health centres needs to be addressed through the implementation of TB suspect tracing and better programme supervision. The national TB algorithm needs to be revised and differentiated according to the level of care.
Keywords: Diagnostic work-up, Tuberculosis, TB DOTS facilities, Indonesia
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