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Free Content Characteristics, management and outcome of patients with recurrent tuberculosis under routine programme conditions in Malawi

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SETTING: All 43 non-private hospitals in Malawi, which registered TB cases between 1 July 1999 and 30 June 2000.

OBJECTIVES: To determine 1) the characteristics, management and treatment outcome, 2) timing of the previous episode of TB, and 3) pattern of drug resistance in patients registered with recurrent smear-positive pulmonary TB.

DESIGN: Retrospective data collection using TB registers and laboratory culture and drug sensitivity registers.

RESULTS: There were 748 recurrent patients; data were available for 747. Of these, 487 (65%) successfully completed a re-treatment regimen, 185 (25%) died and the remainder had another outcome. Information about previous TB was recorded for 491 (66%) patients. In 286 (58%) there were 2 years or less between completing and re-starting treatment. Only 307 (41%) patients had sputum sent for culture and drug sensitivity tests. In 164 patients with cultures of Mycobacterium tuberculosis, 122 (81%) were fully sensitive, 25 (15%) had resistance to isoniazid and/or streptomycin, and 6 (4%) had resistance to isoniazid and rifampicin (MDR-TB).

CONCLUSION: Patients with recurrent TB had acceptable treatment outcomes, and most had fully sensitive organisms. Over half had recurrent TB 2 years or less after completing treatment. Ways to prevent recurrence need to be investigated and implemented in the field.

Keywords: Malawi; recurrent smear-positive TB

Document Type: Regular Paper

Affiliations: 1: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi 2: Community Health Science Unit, National Tuberculosis Control Programme, Lilongwe, Malawi; and the World Health Organization Lilongwe Office, Lilongwe, Malawi 3: Department of Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool, United Kingdom 4: Department of Tropical Medicine and Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom

Publication date: October 1, 2003

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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