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Randomised controlled trial
Two sputum samples at once for diagnosis of tuberculosis in Africa has equivalent sensitivity and specificity to the standard initial sample followed by a morning sample strategy
  1. Nauman Safdar1,
  2. Kamran Siddiqi2
  1. 1Research Fellow, Leeds Institute of Health Sciences, University of Leeds, UK
  2. 2Clinical Senior Lecturer & Consultant in Public Health, Leeds Institute of Health Sciences, University of Leeds, UK
  1. Correspondence to Nauman Safdar Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK; safdar.nauman{at}

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Tuberculosis (TB) persists as a major cause of human morbidity and mortality, affecting almost 9.4 million people and causing 1.8 million deaths yearly worldwide.1 Examining Mycobacterium tuberculosis bacilli, using light microscopy with Ziehl–Neelsen stain, is still considered the most specific, cost-effective, quick and reliable test for the diagnosis of pulmonary TB.2 In recent years, new diagnostics such as ‘Xpert MTB/RIF’ (97.6% sensitivity and 99.2% specificity) have emerged and are being endorsed by the WHO. The ‘Gene Xpert’ has been recommended by WHO to use as a first-line test for multidrug-resistant TB or HIV-associated TB.3

Collecting and processing quality sputum specimens for microscopy is a manageable process but requires trained and dedicated laboratory staff and motivated patients. In reality, most of the peripheral laboratories in high TB burden countries …

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  • Competing interests None.