خطاي سيستم پيگيري اطرافيان بيماران سلي در كشف موارد جديد سل

Error of surveillance system for tuberculosis(TB) patientsʹ closed contacts, in early detection of new cases, Shahrekord & Broojen

In a health system, after finding a sputum positive TB, the closed contacts of the patient are followed-up to detect new cases. The aim of this survey was to assess the effectiveness of the surveillance system in Shahrekord and Broojen. During a 5 year period, 56 files (16 from Broojen and 40 from Shahrekord) of sputum positive TB were selected, and detection of new cases during the next five years was checked. The registered follow-up items included gender, age, vaccination, scar of BCG, smear of sputum, culture of sputum and chest x ray. In Broojen there were 16 patients with 122 closed contacts, from whom 74 persons were close relatives and 23 of them were under 6 years old. In most of the closed contacts the follow-up items were registered. One out of 11 cases of TB patients of the second period was from the closed contacts of first period TB patients. In Shahrekord there were 40 TB and 212 closed contacts with 165 persons at risk. Follow-up items were registered in less than 10% of cases. Eight TB positive cases were reported in closed contacts 10 days to 3 years after the index cases, but there was no follow-up activity for them. Follow-up in Broojen was more regular than in Shahrekord. Unfortunately the follow-up activities in Shahrekord did not end up to case finding. Based on this survey, 9% to 21% of new cases of TB may be due to failure of health system. Performing similar surveys in other health care systems of the country may help to find the probable faults.