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Ouedraogo et al. 2006). Most patients presented with symptoms suspicious for TB; thus, lack of diagnostic sensitivity of health workers is of concern (Wandwalo & Morkve 2000). Afghanistan has the highest TB burden in south Asia (World Health Organization 2007). While health services are expanding and quality improving, gaps in access and deficient quality of some interventions persist. The Ministry of Public Health adopted a Basic Package of Health Services (BPHS) in 2003, which provides standard primary care services for districts covering 77% of the population. However, inequitable service distribution and difficulty motivating access to services make care provision challenging (Waldman et al. 2006). Health data from 2006 indicate that respiratory complaints comprised 60.0%. | Tropical Medicine and International Health doi 10.1111 j.1365-3156.2009.02257.x volume 14 no 5 pp 564-570 may 2009 Prevalence of respiratory symptoms and cases suspicious for tuberculosis among public health clinic patients in Afghanistan 2005-2006 Perspectives on recognition and referral of tuberculosis cases Yolanda Barbera Lainez1 Catherine S. Todd2 Ahmadullah Ahmadzai1 Shannon C. Doocy3 and Gilbert Burnham3 1 International Rescue Committee Kabul Afghanistan 2 Division of International Health Cross-Cultural Medicine University of California San Diego La Jolla CA USA 3 Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA Summary OBJECTIVES To assess diagnosis and management of suspected pulmonary tuberculosis TB among patients with respiratory complaints attending Comprehensive Health Centers CHCs in Afghanistan. METHODS Consecutive consenting patients presenting with respiratory complaints at 24 health centres in eight provinces were enrolled between November 2005 and February 2006. Demographics health histories clinic provider and study representative exam findings and diagnoses and diagnostic test results were recorded. Correlates of TB-suggestive symptoms defined as cough 2 weeks and or haemoptysis were assessed by logistic regression. RESULTS There were 1401 participants 24.6 n 345 were children age 17 or under . The TB-suggestive symptoms of cough 2 weeks and or haemoptysis were reported by 407 31.3 and 44 3.3 respectively with 39 participants reporting both symptoms. Of 413 participants reporting TB-suggestive symptoms only 178 43 were diagnosed as having suspected TB 22.0 received no clinical diagnosis. Suspected TB was significantly associated with having a household member residing in a refugee camp within the last 2 years OR 6.0 95 CI 4.1-8.7 seven or more people sleeping in the same room OR 1.9 95 CI 1.4-2.6 and cooking with a wood fire in the sleeping room OR 1.6 95 CI 1.2-2.2 in univariate analysis. .
