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BACKGROUND The objective of this study was to establish 1) the performance of chest X-ray (CXR) in all suspects of tuberculosis (TB), as well as smear-negative TB suspects and 2) to compare the cost-effectiveness of the routine diagnostic pathway using Ziehl-Neelsen (ZN) sputum microscopy followed by CXR if case of negative sputum result (ZN followed by(More)
SETTING Nairobi City Council Chest Clinic, Kenya. OBJECTIVES To establish the efficiency, costs and cost-effectiveness of six diagnostic strategies using Ziehl-Neelsen (ZN) and fluorescence microscopy (FM). DESIGN A cross-sectional study of 1398 TB suspects attending a specialised chest clinic in Nairobi subjected to three sputum examinations by ZN and(More)
SETTING City Council Chest Clinic, Nairobi, Kenya. OBJECTIVE To determine to what extent the performance of smear microscopy is responsible for sex differences in notification rates. METHODOLOGY Three sputum samples from TB suspects were subjected to smear microscopy with Ziehl-Neelsen (ZN) and auramine (FM) staining. Lowenstein-Jensen culture was used(More)
SETTING A major out-patient tuberculosis clinic in Nairobi, Kenya. OBJECTIVE To ascertain the cost-effectiveness of the polymerase chain reaction (PCR) for the diagnosis of tuberculosis in an urban setting in a developing country. DESIGN A cost-effectiveness analysis of PCR and direct smear microscopy examination based on theoretical modelling. The(More)
BACKGROUND Laboratory services, particularly in large sub-Saharan cities, are overstretched, and it is becoming difficult both for patients and health staff to adhere to the diagnostic procedures for tuberculosis. Alternative techniques would be welcome. The polymerase chain reaction (PCR) has the potential to be cost-effective. We compared the(More)
Tuberculosis (TB) suspects from Rhodes Chest Clinic, Nairobi, Kenya, were subjected to three sputum smear microscopy (Ziehl-Neelsen) examinations and a chest X-ray (CXR). Results were compared with Löwenstein-Jensen culture as the gold standard to establish the efficiency of the routine diagnostic process. All laboratory tests and the CXR were available for(More)
Amongst newly diagnosed pulmonary tuberculosis patients, 44% were co-infected with human immunodeficiency virus (HIV). Pulmonary tuberculosis patients with HIV-1 presented more frequently with lymphadenopathy and diarrhoea than those without HIV-1. Peripheral blood CD4+ counts were significantly lower in patients with pulmonary tuberculosis with HIV-1 than(More)
OBJECTIVE To study patient determinants that may affect completion of the diagnostic process in tuberculosis control, highlighting the role of counselling. DESIGN Cross-sectional study. SUBJECTS TB patients. SETTING Rhodes Chest Clinic, Nairobi, City Council. RESULTS Ninety five percent of the suspects delivered three sputum samples but only 27%(More)
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