Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia
1 Department of Epidemiology, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
2 Department of Environmental Health, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
3 Department of Health Policy and Administration, Faculty of Public Health, Diponegoro University, Semarang, Indonesia
4 District Health Office of Klaten, Central Java, Indonesia
5 District Health Office of Wonogiri, Central Java, Indonesia
6 Department of Internal Medicine, Medical Faculty, Padjadjaran University, Hasan Sadikin Hospital, Bandung, Indonesia
7 TB Operational Research Group, National TB Program, Ministry of Health, Indonesia
8 KNCV Tuberculosis Foundation, The Hague, the Netherlands
9 Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
BMC Pulmonary Medicine 2009, 9:16 doi:10.1186/1471-2466-9-16Published: 8 May 2009
Sputum smear microscopy is the standard diagnostic method for detection of smear positive pulmonary tuberculosis (TB). Insufficient quality of sputum might result in missing cases. In this study we aimed at assessing the quality of sputum in a district in Central Java and determining patient and health worker factors associated with submission of three good quality sputum samples.
In 16 health centers information was collected on the quality of sputum submitted by TB suspects, i.e. volume, color, and viscosity. TB suspects were interviewed to assess their knowledge of TB, motivation to provide sputum and whether they were informed why and how to produce a sputum sample. Health workers were interviewed to assess what information they provided to TB suspects about the reason for sputum examination, methods to produce sputum and characteristics of a good quality sputum sample. All health worker and patient factors were evaluated for association with sputum quality.
Of 387 TB suspects, 294 (76.0%) could be traced and interviewed, and of 272 (70.3%) information about sputum quality was available. Of those 203 (74.6%) submitted three samples, 90 (33.1%) provided at least one good sample, and 37 (13.6%) provided three good quality sputum samples. Of the 272 TB suspects, 168 (61.8%) mentioned that information on the reason for sputum examination was provided, 66 (24.3%) remembered that they were informed about how to produce sputum and 40 (14.7%) recalled being informed about the characteristics of good quality sputum. Paramedics reported to provide often/always information on the importance of sputum examination, and when to produce sputum. Information on how to produce sputum and characteristics of a good sputum sample was less often provided. None of the studied patient characteristics or health worker factors was associated with providing good quality sputum.
A considerable number of TB suspects did not provide three sputum samples and a large number of sputum samples were of insufficient quality. Training of health workers in providing health education to the TB suspect about the reason for sputum examination and how to produce a good quality sputum sample should be a priority of the TB program.