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The prevalence of persistent coughs in a rural community in the Lango District of Uganda
Tubercle 58 (1977)
157-l 59
NOTE
THE PREVALENCE COMMUNITY
OF PERSISTENT
IN THE LANG0
COUGHS
DISTRICT
IN A RURAL
OF UGANDA
P. G. Smith’ and W. D. L. Revill’ Makerere
University MedicalSchool,
Kampala, and The Uganda Ministry of Health, Lira Hospital, Uganda
. Summary During a survey of disease due to M. dcerans in a small rural community in Uganda in 1971 individuals were asked whether they had a cough and how long it had been present. Nine thousand one hundred and seventy-two were questioned. Of these, 4.0 % of males and 4.2 % of females reported a cough of longer than 1 month’s duration. Of 909 aged 50 years or more the proportion was 7.9 % being higher in females (9.8 %) than in males (6.5 %). R&urn6 Lors d’une enquete realisee en 1971 sur les cas d’affections dues a M. ulcerans dans une collectivite rurale d’ouganda, on a egalement demand6 aux sujets examines s’ils toussaient et depuis combien de temps. Neuf mille cent soixante douze personnes ont ainsi 6th interrogees. Parmi elles, 4,0 % sujets de sexe masculin et 4,2 % sujets de sexe feminin ont signale qu’ils toussaient depuis plus d’un mois. Parmi 909 personnes Bgees de 50 ans ou au-dessus, la proportion des tousseurs etait de 7,9 %; elle dtait plus dlevee chez les femmes (9,8 %) que chez les hommes (6,5 %). Resumen Durante un estudio de la enfermedad debida al Micobacterium ulcerans, en una comunidad rural pequeiia de Uganda, en 1971, se le preguntd a la poblacion si tenian tos y por cuanto tiempo. 9.172 personas fueron interrogadas. De Bstas, 4,0 % de hombres y 4,2 % de mujeres, informaron tener tos de m&s de un mes de duration. En loss 905 individuos de 50 aAos o mas de edad, la proporcidn fue de 7,9 %, siendo mas alta en las mujeres (9,8 %) que en 10s hombres (6,5 %). Introduction As part of a study to determine whether BCG vaccination protects against the development of M, ulcerans disease (Smith and others, 1977), an attempt was made to question every member of the population of a subcounty in rural Uganda regarding the presence of a persistent cough. This was done to try to locate the most infectious cases of tuberculosis (Shaw and Wynn-Williams, 1954; Grzbowski, Bennett and Styblo, 1970). There have been few reports of population studies of this kind and the results presented here may be of interest to those concerned with methods of screening populations for the routine detection of tuberculosis cases. 1 Present address: DHSS Cancer Epidemiology and Clinical Trials Unit, 9 Keble Road, Oxford, England. 2 Present address:
Leicestershire Area Health Authority,
Leicester, England.
158
Smith and Reviil Methods
In August/September 1970 an attempt was made to register and tuberculin test the complete population of lbuje subcounty in central Uganda, a fairly remote rural area on the banks of the Nile with a population of about IO 000 and a population density of 66 persons per square mile in 1969. Registration wascompleted in a 6 week period by a mobile team assembling the population of a small area at a locally central point on each day of the survey. The extensive help of local chiefs and elders ensured a high level of registration. A random 50 % of those with low tuberculin reactions were given BCG and the remainder left unvaccinated. The population was resurveyed in 1971 in a similar way to detect new cases of M. ulcerans disease (Smith and others, 1977) and at this time individuals were asked if they had a persistent cough. Specifically, they were asked ‘Do you have a cough at present?’ and, to those replying positively, ‘How long have you had this cough ?’If the cough had persisted for a month of more a sputum specimen was collected. (For technical reasons the bacteriological findings are not reported here.) Results 9172 persons were questioned, 4555 males and 4617 females (see Table I). 181 males (4.0 %) and 194 females (4.2 %) reported a cough of 1 month or more duration. There was a steady rise in the prevalence of such coughs with age, rising from about 2 % in O-l 4 year olds of both sexes to 6.5 % in males and 9.8 % in females after the age of 50 years. The rise among females is more marked than in males but for all ages combined over the age of IO years the level is about 5 %.
Table I. Prevalence of persistent coughs (1 month or more duration) sex for lbuje Subcounty, Lango District of Uganda, 1971
Age
(years)
O5IO1520253035404550+ Not recorded Total Aged 10 years or more
Males Total no. examined
1060 735 571 299 276 300 216 222 199 160 511 6
Females
tabulated
by age and
Total ---~_
No. with % cough for 1 month or more
Totalno. examined
No. with cough for 1 month or more
%
Totalno. examined
No. with cough for 1 month or more
%
21 22 20 11 13 18 12 12 9 9 33 1
2.0 3.0 3.5 3.7 4.7 6.0 5.6 5.4 4.5 5.6 6.5 -
1092 711 465 338 348 353 300 269 153 189 398
26 17 18 10 8 15 15 22 11 13 39 0
2.4 2.4 3.9 3.0 2.3 4.2 5.0 8.2 7.2 6.9 9.8 -
2152 1446 1036 637 624 653 516 491 352 349 909 7
47 39 38 21 21 33 27 34 20 22 72
2.2 2.7 3.7 3.3 3.4 5.1 5.2 6.9 5.7 6.3 7.9 -
4555
181
4.0
4617
194
4.2
9172
375
4.1
2754
137
5.0
2813
151
5.4
5567
288
5.2
Prevalence of persistent coughs in Uganda
159
Comment Although coverage of the population was not complete, probably less than 5 % were missed by the survey teams in 1971 and the findings may therefore be taken as representative of the area studied. It was noted early in this study that individuals were reticent to declare publicly symptoms of tuberculosis and when this was realised the questioning was made more private by restricting it to family groups. However it is possible that had this study been conducted on a house-tohouse basis, with questioning of people in the privacy of their own compounds, a higher prevalence of persistent coughs may have been recorded.
References Grzbowski, S., Bennett, G. 0.. 8 Styblo, K. (1970). Contacts of cases of active pulmonary tuberculosis. Tuberculosis Paris. Surveillance Res. Unit. Progress Report - 1970. Int. Union against Tuberculosis, Shaw, J. B., Et Wynn-Williams, N. (1954). Infectivity of pulmonary tuberculosis in relation to sputum status. American Review of Tuberculosis, 69. 724. Smith, P. G., Revill, W. D. L., Lukwago, E. & Rykushin, Y. P. (1977). The protective effect of BCG against mycobacterium ulcerans disease: a controlled trial in an endemic area of Uganda. Transactions of the Royal Society of Tropical Medicine, 70. 449.
157-l 59
NOTE
THE PREVALENCE COMMUNITY
OF PERSISTENT
IN THE LANG0
COUGHS
DISTRICT
IN A RURAL
OF UGANDA
P. G. Smith’ and W. D. L. Revill’ Makerere
University MedicalSchool,
Kampala, and The Uganda Ministry of Health, Lira Hospital, Uganda
. Summary During a survey of disease due to M. dcerans in a small rural community in Uganda in 1971 individuals were asked whether they had a cough and how long it had been present. Nine thousand one hundred and seventy-two were questioned. Of these, 4.0 % of males and 4.2 % of females reported a cough of longer than 1 month’s duration. Of 909 aged 50 years or more the proportion was 7.9 % being higher in females (9.8 %) than in males (6.5 %). R&urn6 Lors d’une enquete realisee en 1971 sur les cas d’affections dues a M. ulcerans dans une collectivite rurale d’ouganda, on a egalement demand6 aux sujets examines s’ils toussaient et depuis combien de temps. Neuf mille cent soixante douze personnes ont ainsi 6th interrogees. Parmi elles, 4,0 % sujets de sexe masculin et 4,2 % sujets de sexe feminin ont signale qu’ils toussaient depuis plus d’un mois. Parmi 909 personnes Bgees de 50 ans ou au-dessus, la proportion des tousseurs etait de 7,9 %; elle dtait plus dlevee chez les femmes (9,8 %) que chez les hommes (6,5 %). Resumen Durante un estudio de la enfermedad debida al Micobacterium ulcerans, en una comunidad rural pequeiia de Uganda, en 1971, se le preguntd a la poblacion si tenian tos y por cuanto tiempo. 9.172 personas fueron interrogadas. De Bstas, 4,0 % de hombres y 4,2 % de mujeres, informaron tener tos de m&s de un mes de duration. En loss 905 individuos de 50 aAos o mas de edad, la proporcidn fue de 7,9 %, siendo mas alta en las mujeres (9,8 %) que en 10s hombres (6,5 %). Introduction As part of a study to determine whether BCG vaccination protects against the development of M, ulcerans disease (Smith and others, 1977), an attempt was made to question every member of the population of a subcounty in rural Uganda regarding the presence of a persistent cough. This was done to try to locate the most infectious cases of tuberculosis (Shaw and Wynn-Williams, 1954; Grzbowski, Bennett and Styblo, 1970). There have been few reports of population studies of this kind and the results presented here may be of interest to those concerned with methods of screening populations for the routine detection of tuberculosis cases. 1 Present address: DHSS Cancer Epidemiology and Clinical Trials Unit, 9 Keble Road, Oxford, England. 2 Present address:
Leicestershire Area Health Authority,
Leicester, England.
158
Smith and Reviil Methods
In August/September 1970 an attempt was made to register and tuberculin test the complete population of lbuje subcounty in central Uganda, a fairly remote rural area on the banks of the Nile with a population of about IO 000 and a population density of 66 persons per square mile in 1969. Registration wascompleted in a 6 week period by a mobile team assembling the population of a small area at a locally central point on each day of the survey. The extensive help of local chiefs and elders ensured a high level of registration. A random 50 % of those with low tuberculin reactions were given BCG and the remainder left unvaccinated. The population was resurveyed in 1971 in a similar way to detect new cases of M. ulcerans disease (Smith and others, 1977) and at this time individuals were asked if they had a persistent cough. Specifically, they were asked ‘Do you have a cough at present?’ and, to those replying positively, ‘How long have you had this cough ?’If the cough had persisted for a month of more a sputum specimen was collected. (For technical reasons the bacteriological findings are not reported here.) Results 9172 persons were questioned, 4555 males and 4617 females (see Table I). 181 males (4.0 %) and 194 females (4.2 %) reported a cough of 1 month or more duration. There was a steady rise in the prevalence of such coughs with age, rising from about 2 % in O-l 4 year olds of both sexes to 6.5 % in males and 9.8 % in females after the age of 50 years. The rise among females is more marked than in males but for all ages combined over the age of IO years the level is about 5 %.
Table I. Prevalence of persistent coughs (1 month or more duration) sex for lbuje Subcounty, Lango District of Uganda, 1971
Age
(years)
O5IO1520253035404550+ Not recorded Total Aged 10 years or more
Males Total no. examined
1060 735 571 299 276 300 216 222 199 160 511 6
Females
tabulated
by age and
Total ---~_
No. with % cough for 1 month or more
Totalno. examined
No. with cough for 1 month or more
%
Totalno. examined
No. with cough for 1 month or more
%
21 22 20 11 13 18 12 12 9 9 33 1
2.0 3.0 3.5 3.7 4.7 6.0 5.6 5.4 4.5 5.6 6.5 -
1092 711 465 338 348 353 300 269 153 189 398
26 17 18 10 8 15 15 22 11 13 39 0
2.4 2.4 3.9 3.0 2.3 4.2 5.0 8.2 7.2 6.9 9.8 -
2152 1446 1036 637 624 653 516 491 352 349 909 7
47 39 38 21 21 33 27 34 20 22 72
2.2 2.7 3.7 3.3 3.4 5.1 5.2 6.9 5.7 6.3 7.9 -
4555
181
4.0
4617
194
4.2
9172
375
4.1
2754
137
5.0
2813
151
5.4
5567
288
5.2
Prevalence of persistent coughs in Uganda
159
Comment Although coverage of the population was not complete, probably less than 5 % were missed by the survey teams in 1971 and the findings may therefore be taken as representative of the area studied. It was noted early in this study that individuals were reticent to declare publicly symptoms of tuberculosis and when this was realised the questioning was made more private by restricting it to family groups. However it is possible that had this study been conducted on a house-tohouse basis, with questioning of people in the privacy of their own compounds, a higher prevalence of persistent coughs may have been recorded.
References Grzbowski, S., Bennett, G. 0.. 8 Styblo, K. (1970). Contacts of cases of active pulmonary tuberculosis. Tuberculosis Paris. Surveillance Res. Unit. Progress Report - 1970. Int. Union against Tuberculosis, Shaw, J. B., Et Wynn-Williams, N. (1954). Infectivity of pulmonary tuberculosis in relation to sputum status. American Review of Tuberculosis, 69. 724. Smith, P. G., Revill, W. D. L., Lukwago, E. & Rykushin, Y. P. (1977). The protective effect of BCG against mycobacterium ulcerans disease: a controlled trial in an endemic area of Uganda. Transactions of the Royal Society of Tropical Medicine, 70. 449.