Health> Vol.6 No.15, August 2014

Determinants of Persistent Sputum Smear Positivity after Intensive Phase Chemotherapy among Patients with Tuberculosis at Rhodes Chest Clinic, Nairobi, Kenya

DownloadDownload as PDF (Size:2526KB)  HTML    PP. 2026-2034  

ABSTRACT

The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.

Cite this paper

Maingi, D. , Mutugi, M. , Wanzala, P. , Mutai, J. and Mwaniki, P. (2014) Determinants of Persistent Sputum Smear Positivity after Intensive Phase Chemotherapy among Patients with Tuberculosis at Rhodes Chest Clinic, Nairobi, Kenya. Health, 6, 2026-2034. doi: 10.4236/health.2014.615237.

References

[1] Maher, D.R.M. (2005) Global Epidemiology of Tuberculosis. Clinics in Chest Medicine, 26, 167-182.
[2] Saito, M.B.C., Gilman, R.H., Bowering, A., Levy, M.Z. and Evans, C.A. (2004) The Value of Counting BCG Scars for Interpretation of Tuberculin Skin Tests in a Tuberculosis Hyperendemic Shantytown, Peru. The International Journal of Tuberculosis and Lung Disease, 14, 429-437.
[3] Division of Leprosy, Tuberculosis and Lung Diseases, Ministry of Public Health and Sanitation (2009) Guidelines for TB and Leprosy Control. Nairobi, Kenya.
[4] WHO Stop TB Partnership (2006) The Global Plan to Stop TB, 2006-2015. Actions for Life: Towards a World Free of Tuberculosis. 10, 240-1.
[5] Githui, W.A., et al. (2004) Isolation of Multidrug-Resistant Tuberculosis Strains in Patients from Private and Public Health Care Facilities in Nairobi, Kenya. The International Journal of Tuberculosis and Lung Disease, 8, 837-841.
[6] Raguenad, M.Z.R., Massaquoi, M., Ombeka, V., Ritter, H. and Chakaya, J.M. (2008) High Adherence to Anti-Tuberculosis Treatment among Patients Attending a Hospital and Slum Health Centre in Nairobi, Kenya. Global Public Health: An International Journal for Research, Policy and Practice, 3, 433-439.
[7] Maruza, M., et al. (2011) Risk Factors for Default from Tuberculosis Treatment in HIV-Infected Individuals in the State of Pernambuco, Brazil: A Prospective Cohort Study. BMC Infectious Diseases, 11, 351.
[8] Morisky, D.E., et al. (2008) Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. Journal of Clinical Hypertension (Greenwich, Conn.), 10, 348-354.
[9] Munro, S.A., Lewin, S.A., Smith, H.J., Engel, M.E., Fretheim, A., et al. (2007) Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research. PLoS Med, 4.
[10] Calver, A.D., et al. (2010) Emergence of Increased Resistance and Extensively Drug-Resistant Tuberculosis despite Treatment Adherence, South Africa. Emerging Infectious Disease, 16, 264-271.
[11] Chang, K.C., et al. (2004) Risk Factors for Defaulting from Anti-Tuberculosis Treatment under Directly Observed Treatment in Hong Kong. The International Journal of Tuberculosis and Lung Disease, 8, 1492-1498.
[12] Lienhardt, C., et al. (2001) Factors Affecting Time Delay to Treatment in a Tuberculosis Control Programme in a Sub-Saharan African Country: The Experience of the Gambia. The International Journal of Tuberculosis and Lung Disease, 5, 233-239.
[13] Banu Rekha, V.V., et al. (2007) Sputum Conversion at the End of Intensive Phase of Category-1 Regimen in the Treatment of Pulmonary Tuberculosis Patients with Diabetes Mellitus or HIV Infection: An Analysis of Risk Factors. Indian Journal of Medical Research, 126, 452-458.

  
comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.