The quality of tuberculosis diagnosis in districts of Tigray region of Northern Ethiopia

Background: Low detection of smear-positive and over-diagnosis of smear-negative Pulmonary Tuberculosis (PTB) are major problems in Ethiopia. Non-adherence to diagnostic guidelines could be contributing to the poor detection of tuberculosis. Objective: To assess the quality of diagnosis based on the national tuberculosis guidelines.Methods: A retrospective diagnostic audit was made in eight districts among patients aged 815 years that were on TB treatment between 12/10/2001 and 15/05/2002. A team of three physicians reviewed patient charts, sputum microscopy and radiograph registers to assess diagnostic criteria used to each patient. Results: A total of 237 patients were reviewed: 42 were smear-positive, 101 were smear-negative PTB and 94 were extra-pulmonary tuberculosis. The diagnosis was considered correct in 33 of the 42 smear-positive PTB patients and incorrect in 9 patients. Of 101 smear-negative PTB patients, 31 (31%) were diagnosed as per the national diagnostic guideline. In more than half of patients treated for lymph node tuberculosis their diagnosis was inconsistent with the national diagnostic guideline.Conclusion: Non-adherence to the national guidelines is a major problem in district hospitals. This calls for action to promote clinicians' adherence to the national diagnostic guidelines.The Ethiopian Journal of Health Development Vol. 19 2005: 13-20