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Free Content Impact of smear microscopy results and observed therapy on tuberculosis treatment in Mombasa, Kenya

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SETTING: Tuberculosis (TB) treatment center at Coast Provincial General Hospital in Mombasa, Kenya.

OBJECTIVES: To describe TB management practices in a facility in coastal Kenya and identify factors associated with poor treatment outcomes.

DESIGN: Retrospective review of patient treatment records from January 2008 to June 2009. Treatment outcomes of patients were classified as treatment success (cure or treatment completion) or poor treatment outcome (treatment failure, death or default). Relative risk regression was used to determine the association between exposures of interest and poor treatment outcomes.

RESULTS: Records were obtained from a total of 183 patients: 142 (78%) had pulmonary TB, 68 (37%) were human immunodeficiency virus (HIV) infected and 81 (44%) had acid-fast bacilli (AFB) positive smear micros- copy. Most treated individuals (86%) achieved a successful treatment outcome as defined by the World Health Organization. Of those with poor treatment outcomes, 64% defaulted, 32% died, and 4% failed treatment. Initial negative AFB smear and HIV co-infection were associated with poor treatment outcomes (RR 3.32, 95%CI 1.22–8.99 and RR 4.61, 95%CI 1.69– 12.59, respectively).

CONCLUSION: Strategies to accelerate accurate diagnosis of smear-negative TB and increase patient retention during treatment, especially in HIV co-infected individuals, are needed to reduce poor treatment outcomes in Kenya.
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Keywords: KENYA; MOMBASA; OBSERVED THERAPY; SMEAR MICROSCOPY; TUBERCULOSIS

Document Type: Research Article

Affiliations: 1: Department of Medicine, University of Washington, Seattle, Washington, USA 2: Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Global Health, University of Washington, Seattle, Washington, USA; Tuberculosis Control Program, Department of Public Health, Seattle and King County, Seattle, Washington, USA 3: Department of Epidemiology, University of Washington, Seattle, Washington, USA 4: School of Medicine, University of Washington, Seattle, Washington, USA 5: Pomona College, Claremont, California, USA 6: Coast Provincial General Hospital, Mombasa, Kenya 7: Center for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya 8: Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Public Health and Sanitation, Nairobi, Kenya 9: Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Global Health, University of Washington, Seattle, Washington, USA; Tuberculosis Control Program, Department of Public Health, Seattle and King County, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA; Department of Pediatrics, University of Washington, Seattle, Washington, USA; Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya

Publication date: December 1, 2011

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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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