Feasibility for Same Day Tuberculosis Diagnosis Using the Smear Microscopy Approach in Rural South Western Uganda

Background: WHO recently recommended the collection of two sputum smears and that these specimens can be collected in an accelerated scheme called front-loaded or same-day microscopy. We studied the feasibility of same day sputum smear microscopy in rural refugee settlement in South Western Uganda.

Methods: Sputum specimens were collected from tuberculosis suspects at two health centers in Nakivale refugee settlement in South Western Uganda. Patients submitted 2 spot samples one hour apart and an early morning sample was submitted the next day. All samples were stained by Ziehl-Nielsen stain. Results for the two spot samples were given on day one and the morning sample results were given on day 2. Patients found to have TB were referred for treatment on reception of their results.

Results: Of the 316 TB suspects, 190(60.1%) were males and 126(39.9%) were females. The mean age of the TB suspects was 40 years. Overall smear positivity rate was 46/316(15.0%). Of the 40 smear positive TB cases, 38(95.0%) were positive on the spot1, 35 (92.5%), on spot 2 while 31(85.0%) were positive on the early morning specimen. Only one TB suspect had negative sport1 sample that was positive with spot2 and early morning. Three TB suspects who had positive spot1 result did not return with spot2 sample. Six (15%) patients with a positive spot 1 did not bring the early morning sample. Though the bacillary load differed on the spot2 and morning samples the difference was not significant p-value > 0.05, all samples that were positive on morning sample were also positive on the spot 2. There was no association between HIV and TB infection.

Conclusion: Same day smear microscopy for diagnosing tuberculosis is feasible in a rural setup by examining two spot samples.