Tuberculosis case-finding in Nicaragua: evaluation of routine activities in the control programme.

Setting: The new International Union against Tuberculosis and Lung Disease (IUATLD) tuberculosis strategy developed in the 1980s in Tanzania, Malawi and Mozambique, was simultaneously implemented in Nicaragua.

Objective: Present results of case-finding, identify trends in incidence and limitations in case-finding and reporting.

Design: Data are based upon the traditional reporting system until 1987, replaced as the programme was reorganized. Data were also collected directly from the Central Laboratory, Programme and Laboratory registers during supervision of health centres.

Results: Quality control of sputum smears shows 1.8% discordance between peripheral and central laboratories. Notification rate of smear-positive tuberculosis declined 1.7% yearly 1983-1991 and 2.6% for all cases. Half of the patients are new smear-positive pulmonary cases, 40% smear-negative pulmonary cases. Relapses represent 11-13% of all smear-positive patients, children 7-30% of all cases. One-third of extrapulmonary tuberculosis cases are pleural effusions, another third lymphadenitis. 41% of adult patients entered as smear-negative in the programme had no smear reported in the laboratory.

Conclusions: Quality control of sputum smears was established and the reporting system improved in spite of adverse conditions. Notification rate declined gradually. Smears should be done in all patients classified as smear-negative pulmonary tuberculosis.