Design. A pair-matched, cluster-randomized trial of a door to door symptom screen and spot sputum collection vs. home delivery of an informational pamphlet in a large Brazilian favela (slum).
Aims. to compare tuberculosis (TB) case notification rates and times from symptom onset to treatment start in the two arms.
Methods. 14 administrative zones in the favela Rocinha were pair-matched based on estimated TB case notification rates in 2003. One zone of each pair was randomly allocated to receive a door to door symptom screen and sputum collection from all symptomatic individuals. The other zone of each pair concurrently received TB educational pamphlets. Active TB cases were interviewed to measure symptom duration and reason for seeking care. Case notification rates were compared using paired t-tests on the mean rate differences. Times to diagnosis were adjusted for factors associated with symptom duration in linear regression and compared using paired t-tests. Rate ratios and 95% confidence intervals were calculated.
Results. 196 cases were identified (case detection rate 334/100,000), 102 from the pamphlet arm of the study, and 94 from the intervention arm. Of the 94 cases found in the intervention arm, 12(13%) were new, AFB positive pulmonary cases identified at the home. Case detection rates during the intervention in the door to door arm were 9.34/1000 person years vs. 6.04/1000 person years in the pamphlet arm (RR 1.55 (95%CI: 1.52, 1.65; p value .03). Case detection rates were not significantly different 60 days after the intervention (RR 1.11 (0.53, 1.69; p value .51). One hundred and four TB cases were interviewed; 50 (48%) from the pamphlet arm, 54 (52%) from the door to door arm. Mean (range) cough days by intervention were 55 (7-224) and 58 (7-336) for pamphlet and door to door arms respectively. Median days were 56 and 35 respectively. No significant differences were found in time from cough onset to treatment start.
Conclusion. Door to door case finding appears effective at detecting prevalent cases and influencing people to come for care in this setting, however, no statistically significant effect on time to diagnosis was observed in this study.
|Advisor:||Chaisson, Richard E.|
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 68/04, Dissertation Abstracts International|
|Subjects:||Public health, Epidemiology|
|Keywords:||Brazil, Symptom screening, Tuberculosis|
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