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Open Access Research article

Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia

Riris Andono Ahmad12*, Francine Matthys3, Bintari Dwihardiani1, Ning Rintiswati4, Sake J de Vlas2, Yodi Mahendradhata13 and Patrick van der Stuyft3

Author Affiliations

1 Centre for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia

2 Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

3 Unit of Epidemiology & Disease Control, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium

4 Department of Microbiology, Faculty of Medicine, Gadjah Mada University, Jogjakarta, Indonesia

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BMC Public Health 2012, 12:132  doi:10.1186/1471-2458-12-132

Published: 15 February 2012

Abstract

Background

Early and accurate diagnosis of pulmonary tuberculosis (TB) is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO) recommends the use of a diagnostic algorithm. Our study evaluated the implementation of the national tuberculosis programme's diagnostic algorithm in routine health care settings in Jogjakarta, Indonesia. The diagnostic algorithm is based on the WHO TB diagnostic algorithm, which had already been implemented in the health facilities.

Methods

We prospectively documented the diagnostic work-up of all new tuberculosis suspects until a diagnosis was reached. We used clinical audit forms to record each step chronologically. Data on the patient's gender, age, symptoms, examinations (types, dates, and results), and final diagnosis were collected.

Results

Information was recorded for 754 TB suspects; 43.5% of whom were lost during the diagnostic work-up in health centres, 0% in lung clinics. Among the TB suspects who completed diagnostic work-ups, 51.1% and 100.0% were diagnosed without following the national TB diagnostic algorithm in health centres and lung clinics, respectively. However, the work-up in the health centres and lung clinics generally conformed to international standards for tuberculosis care (ISTC). Diagnostic delays were significantly longer in health centres compared to lung clinics.

Conclusions

The high rate of patients lost in health centres needs to be addressed through the implementation of TB suspect tracing and better programme supervision. The national TB algorithm needs to be revised and differentiated according to the level of care.

Keywords:
Diagnostic work-up; Tuberculosis; TB DOTS facilities; Indonesia