The diagnosis of smear-negative pulmonary tuberculosis: the practice of sputum smear examination in Malawi

SETTING: Forty hospitals in Malawi (3 central, 22 district and 15 mission) performing smear microscopy and registering tuberculosis patients. OBJECTIVE: To determine, in patients aged 15 yeats or above, 1) the proport ion with smear-negative pulmonary tuberculosis (PTB) who had sputum smears examined, 2) the number of sputum smears examined per patient, and 3) the p roportion of patients registered with smear-positive and smear-negative PTB . DESIGN: Data collection during three 6-month periods, from January 1997 to June 1998, using tuberculosis registers, laboratory sputum registers and qu arterly reports. RESULTS: Of 6301 smear-negative PTB patients, 84% had sputum smears examine d, the rate increasing from 76% in January-June 1997, to 85% in July-Decemb er 1997, to 89% in January-June 1998, Of patients who submitted sputum (whe re the number of smears was recorded), 99% had two or more smears examined and 93% had three smears examined. Ln district and mission hospitals perfor mance improved over time, while in central hospitals results were more vari able. During the same 18-month period 21 422 patients aged 15 years or more were registered with PTB: 59% with smear-positive PTB and 41% with smear-n egative PTB; this pattern was similar in each 6-month period. CONCLUSION: The study suggests that it is reasonable to aim for a target of 90% or more of smear-negative PTB patients having sputum smears examined.