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

D. Maingi, M. Mutugi, P. Wanzala, J. Mutai, P. Mwaniki

Jomo Kenyatta University of Agriculture and Technology (JKUAT), Institute of Tropical Medicine and Infectious Diseases, Nairobi, Kenya.
Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
School of Health Sciences, Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya.

DOI: 10.4236/health.2014.615237                

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.

Keywords

Tuberculosis Treatment in Kenya, Intensive Phase, Persistent Sputum Positivity, TB Drug Resistance, Adherence to TB Medication

Conflicts of Interest

The authors declare no conflicts of interest.

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