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.

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. CONCLUSIONS: Diagnostic sensitivity by the health worker for possible cases of pulmonary TB was low, as 22% of persons with suspected tuberculosis received no diagnosis. Further, some common/chronic respiratory ailments were under-diagnosed. There is great need for improved practical training and continuing education in pulmonary disease diagnosis for clinical health workers.

Population-based tuberculin skin testing and prevalence of tuberculosis infection in Afghanistan.

OBJECTIVE: A tuberculin skin-test survey was conducted in eight provinces of Afghanistan to estimate the prevalence and annual risk of tuberculosis infection among the Afghan population. METHODS: A cluster survey in eight Afghan provinces, chosen based on population density and geographic distribution, was carried out between October and February 2006. Interviews were conducted and tuberculin skin tests were administered and read. FINDINGS: 11,413 individuals participated in the study. Using the international standard cut-off of >or= 10 mm, tuberculosis prevalence and annual risk of infection in the population were 15% (CI: 14.4-15.7) and 0.80 (CI: 0.76-0.84), respectively. Tuberculosis prevalence was higher in rural than in urban areas. Other risk factors included age, prior tuberculosis treatment or contact, productive cough or cough >3 weeks, no prior bacille Calmette Guérin (BCG) vaccination and a cooking fire in the sleeping room. CONCLUSIONS: The survey documented a lower prevalence and risk of tuberculosis infection than the 1978 national survey and a substantially lower estimate of incidence of new smear-positive tuberculosis cases than World Health Organization estimates. However, other findings suggest that active tuberculosis may remain widespread and undiagnosed, and indicate a need for both additional research and continued investment in tuberculosis treatment and prevention, and in health infrastructure.

Prevalence of human immunodeficiency virus infection, risk behavior, and HIV knowledge among tuberculosis patients in Afghanistan.

OBJECTIVES/GOAL: To assess prevalence and correlates of human immunodeficiency virus (HIV) infection, risk factors, and HIV knowledge among tuberculosis patients in Afghanistan. STUDY DESIGN: Adult participants undergoing treatment for tuberculosis in this cross-sectional study completed a questionnaire and HIV testing between November 2005 and February 2006. Prevalence of HIV and high-risk behaviors were calculated, with correlates of high-risk behavior and relevant knowledge assessed. RESULTS: Of 1163 participants, 2 (0.2%, 95% CI: 0.0-0.6) were HIV-infected. Known risk factors for HIV infection, such as paying women for sex or male to male sexual contact, were rarely reported, though receipt of injections from a nonmedical provider was common (38%). Symptoms suspicious for sexually transmitted infection were reported by 5% of the population and were significantly associated with young (<26 years) age (OR: 3.2, 95% CI: 1.7-6.0). Relatively, a few participants had ever heard of HIV (23%) or condoms (25%). Condom use was significantly more frequent among those 26 and older (OR: 2.9, 95% CI: 1.7-5.2) and among male participants (OR: 1.5, 95% CI: 1.0-2.2). CONCLUSIONS: HIV prevalence among tuberculosis patients in Afghanistan is currently quite low. However, lack of knowledge of HIV and engaging in high-risk practices, particularly regarding health, make this group vulnerable. Health education sessions regarding HIV, sexually transmitted infection, and blood-borne infections should be implemented for tuberculosis patients during the treatment course.