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Journal of Tropical Medicine
Volume 2009, Article ID 398767, 6 pages
Research Article

Front-Loading Sputum Microscopy Services: An Opportunity to Optimise Smear-Based Case Detection of Tuberculosis in High Prevalence Countries

1Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
2UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, 1211 Geneva 27, Switzerland
3TB and Leprosy Control Programme, Southern Region Health Bureau, P.O. Box 149, Awassa, Ethiopia
4Zankli Medical Centre, P.O. Box 7745, Abuja, Nigeria
5Bushullo Major Health Centre, P.O. Box 5, Awassa, Ethiopia
6National Tuberculosis Institute, Sana'a, Yemen
7Microbiology and Parasitology and Health Research Laboratory, Infectious and Tropical Disease Research Centre, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal P.O. Box 10404, Nepal

Received 14 October 2008; Revised 16 January 2009; Accepted 30 January 2009

Academic Editor: Marcel Tanner

Copyright © 2009 Andy Ramsay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Setting. Ethiopia, Nepal, Nigeria, and Yemen. Objective. To reduce the time to complete sputum microscopy. Design. Cross-sectional surveys enrolling 923 patients with chronic cough in the 4 countries and using similar protocols. Spot-morning-spot sputum specimens were collected. An additional sputum specimen (Xspot) was collected one hour after the first, and the yields of the first two or the three specimens collected as spot-morning-spot or spot-Xspot-morning were compared. Results. 216 patients had one positive smear. 210 (97%) were identified by the spot-morning-spot, and 210 (97%) were identified by the spot-Xspot-morning specimens, with 203 and 200 identified by the first 2 specimens of each approach, respectively. Neither difference was significant. Conclusions. The time to complete smear microscopy could be reduced.