A Triage System For The Early Detection Of Chronic Cough Among TB Suspects Attending A Hospital In Banda Aceh, Indonesia

Background and Aims: One of the main strategies for the early detection of pulmonary tuberculosis (PTB) is through the screening of individuals with symptoms compatible with TB. In the hospital, people with symptoms compatible with TB have an opportunity to get proper diagnosis and treatment. Yet this opportunity is often missed. We hypothesize that a respiratory triage system recommended by WHO for prevention of the spread of respiratory infection at the outpatient department, can be improved to enhance early detection of TB. With this hypothesis an inter- vention study was conducted at Zainal Abidin Hospital. The objective of this intervention study was to compare the proportion of patients with cough >2 weeks, offered sputum test and TB case detection rate before versus after a respiratory triage system introduced. Methods: Before-and-after interventional study. Intervention; training of health personnel and setting up a respiratory triage system, to detect patients with >2 weeks cough and offering sputum test for acid-fast bacilli. Data from “exit poll” and central laboratory were compared before vs after the triage set up. Results: After the intervention, sampled patients who visited the hospital were more likely to be asked on >2 weeks cough (85.3% vs17.9%). In the whole samples (99.2% vs 64.7%) among them have >2 weeks cough patients. For TB detection, the changes were 39 positive results from 220 AFB tests of 61,871 outpatients to 55 positive from 365 AFB tests among 53,056 outpatients. The rates of sputum testing and TB case detection increased from 3.5 to 6.8 per 1,000 (OR=1.9, 95% CI=1.6-2.3) and 6.3 to 10.4 per 10,000 (OR=1.7, 95% CI=1.1-2.6) respectively. Conclusions: Respiratory triage can significantly increase TB detection rate