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Wardani DWSR, Pramesona BA, Septiana T, Soemarwoto RAS. Risk factors for delayed sputum conversion: A qualitative case study from the person-in-charge of TB program's perspectives. J Public Health Res 2023; 12:22799036231208355. [PMID: 37901194 PMCID: PMC10605690 DOI: 10.1177/22799036231208355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background One of the indicators to determine the success of TB treatment is the conversion of sputum from smear positive to negative. However, several factors can lead to this failure of sputum conversion. Objectives To investigate the risk factors for delayed sputum conversion from the person-in-charge (PIC) of the TB program's perspective. Design and methods This qualitative case study was conducted on September 7th, 2022. Thirty-one PICs of the TB program from 31 public health centers (Puskesmas) in Bandar Lampung, Indonesia, were recruited purposively. All participants were grouped into three FGDs. Developed semi-structured interview questions were used for data collection. Thematic analysis was used to synthesize and cross-reference emerging topics. Results Three themes emerged in our study: (1) individual factors with the sub-themes of medication adherence, education, initial laboratory examination, comorbid disease, nutrition, and lifestyle; (2) environmental factors with the sub-themes of types of support, sources of support, environmental conditions and stigma; and (3) health service factors with the sub-theme of access to health service facilities. Conclusions Problems related to TB management are not only the individual's responsibility but need to strengthen support from the environment and health services.
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Affiliation(s)
| | - Bayu Anggileo Pramesona
- Department of Public Health, Faculty of Medicine, Universitas Lampung, Bandar Lampung, Indonesia
| | - Trisya Septiana
- Department of Informatics Engineering, Faculty of Engineering, Universitas Lampung, Bandar Lampung, Indonesia
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Mvo S, Bokop C, Longo-Mbenza B, Vasaikar SD, Apalata T. Prolongation of Acid-Fast Bacilli Sputum Smear Positivity in Patients with Multidrug-Resistant Pulmonary Tuberculosis. Pathogens 2023; 12:1133. [PMID: 37764941 PMCID: PMC10537881 DOI: 10.3390/pathogens12091133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The study sought to determine factors associated with prolonged smear positivity in multidrug-resistant tuberculosis (MDR-TB) patients following appropriate management. Newly diagnosed patients were enrolled between June 2017 and May 2018. Sputum samples were collected for Xpert® MTB/RIF and line probe assays (LiPAs). Microscopic tests were performed at baseline and 4, 8, and 12 weeks post-anti-TB therapy. Of the 200 patients, 114 (57%) were HIV-positive. After 12 weeks of treatment, there was a significant microscopy conversion rate among DS-TB patients compared to MDR-TB patients irrespective of their HIV status (p = 0.0013). All MDR-TB patients who had a baseline smear grade ranging from scanty to +1 converted negative, while 25% ranging from +2 to +3 remained positive until the end of 12 weeks (p = 0.014). Factors associated with smear positivity included age <35 years (p = 0.021), initial CD4+ T-cell count ≥200 cells/mm3 (p = 0.010), and baseline smear grade ≥2+ (p = 0.014). Cox regression showed that only the baseline smear grade ≥2+ was independently associated with prolonged smear positivity in MDR-TB patients (p = 0.011) after adjusting for HIV status, CD4+ T-cell count, and age. Baseline sputum smear grade ≥2+ is a key determinant for prolonged smear positivity beyond 12 weeks of effective anti-TB therapy in MDR-TB patients.
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Affiliation(s)
- Sidwell Mvo
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
| | - Carine Bokop
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
- Vaccine and Infectious Disease Analytics Research Unit, University of the Witwatersrand, Johannesburg 2000, South Africa
| | - Benjamin Longo-Mbenza
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
| | - Sandeep D. Vasaikar
- Department of Medical Microbiology, National Health Laboratory Services, Nelson Mandela Academic Complex, Mthatha 5100, South Africa;
| | - Teke Apalata
- Division of Medical Microbiology, Department of Pathology & Laboratory Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha 5100, South Africa; (S.M.); (C.B.); (B.L.-M.)
- Department of Medical Microbiology, National Health Laboratory Services, Nelson Mandela Academic Complex, Mthatha 5100, South Africa;
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Ibrahim MN, Nik Husain NR, Daud A, Chinnayah T. Epidemiology and Risk Factors of Delayed Sputum Smear Conversion in Malaysian Aborigines with Smear-Positive Pulmonary Tuberculosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042365. [PMID: 35206552 PMCID: PMC8872111 DOI: 10.3390/ijerph19042365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/12/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
Background: Tuberculosis (TB) remains a serious public health challenge despite enormous eradication efforts. Indigenous groups worldwide have a higher TB incidence and associated delayed sputum–smear conversion. The aim of this case–control study was to determine the epidemiology and factors associated with delayed sputum–smear conversion among Malaysian aborigines. Methods: We used secondary data from 2016 to 2020 in the MyTB surveillance system. Malaysian aborigines with smear-positive pulmonary TB were enrolled and followed until the end of the intensive phase. Descriptive statistics and multiple logistic regression were used for data analysis. Results: Of 725 Malaysian aborigines with pulmonary TB, 572 (78.9%) were smear-positive and 487 (78.9%) fulfilled the study criteria. The mean (SD) age of smear-positive pulmonary TB was 39.20 (16.33) years. Majority of participants were male (63%), Senoi tribe (54.9%), living in rural areas (88.1%), formally educated (60.4%) and living below the poverty line (97.1%). Overall, 93 (19.1%) of 487 patients showed delayed sputum-smear conversion and significantly associated factors, such as smoking (AdjOR: 3.25; 95% CI: 1.88, 5.59), diabetes mellitus (AdjOR: 12.84; 95% CI: 6.33, 26.06), and HIV infection (AdjOR: 9.76; 95% CI: 3.01, 31.65). Conclusions: Stakeholders should adopt targeted approaches to tackle the problem of aboriginal groups with pulmonary TB and these associated risk factors to realise the End TB target.
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Affiliation(s)
- Muhammad Naim Ibrahim
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia; (M.N.I.); (A.D.)
| | - Nik Rosmawati Nik Husain
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia; (M.N.I.); (A.D.)
- Correspondence: ; Tel.: +60-9767-6621
| | - Aziah Daud
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia; (M.N.I.); (A.D.)
| | - Thilaka Chinnayah
- TB and Leprosy Control Sector, Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia;
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Mokti K, Md Isa Z, Sharip J, Abu Bakar SN, Atil A, Hayati F, Syed Abdul Rahim SS. Predictors of delayed sputum smear conversion among pulmonary tuberculosis patients in Kota Kinabalu, Malaysia: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26841. [PMID: 34397855 PMCID: PMC8341317 DOI: 10.1097/md.0000000000026841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Smear-positive pulmonary tuberculosis (SPPTB) is the major contributor to the spread of tuberculosis (TB) infection, and it creates high morbidity and mortality worldwide. The objective of this study was to determine the predictors of delayed sputum smear conversion at the end of the intensive phase of TB treatment in Kota Kinabalu, Malaysia.This retrospective study was conducted utilising data of SPPTB patients treated in 5 TB treatment centres located in Kota Kinabalu, Malaysia from 2013 to 2018. Pulmonary TB (PTB) patients included in the study were those who had at least completed the intensive phase of anti-TB treatment with sputum smear results at the end of the 2nd month of treatment. The factors associated with delayed sputum smear conversion were analyzed using multiple logistic regression analysis. Predictors of sputum smear conversion at the end of intensive phase were evaluated.A total of 2641 patients from the 2013 to 2018 periods were included in this study. One hundred eighty nine (7.2%) patients were identified as having delayed sputum smear conversion at the end of the intensive phase treatment. Factors of moderate (advanced odd ratio [aOR]: 1.7) and advanced (aOR: 2.7) chest X-ray findings at diagnosis, age range of >60 (aOR: 2.1), year of enrolment 2016 (aOR: 2.8), 2017 (aOR: 3.9), and 2018 (aOR: 2.8), smokers (aOR: 1.5), no directly observed treatment short-course (DOTS) supervisor (aOR: 6.9), non-Malaysian citizens (aOR: 1.5), and suburban home locations (aOR: 1.6) were associated with delayed sputum smear conversion at the end of the intensive phase of the treatment.To improve sputum smear conversion success rate, the early detection of PTB cases has to be fine-tuned so as to reduce late or severe case presentation during diagnosis. Efforts must also be in place to encourage PTB patients to quit smoking. The percentage of patients assigned with DOTS supervisors should be increased while at the same time ensuring that vulnerable groups such as those residing in suburban localities, the elderly and migrant TB patients are provided with proper follow-up treatment and management.
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Affiliation(s)
- Khalid Mokti
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Zaleha Md Isa
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Julaidah Sharip
- Kota Kinabalu District Health Office, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Sahrol Nizam Abu Bakar
- Kota Kinabalu District Health Office, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Azman Atil
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Syed Sharizman Syed Abdul Rahim
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
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Fibriana AI, Saefurrohim MZ, Setiana AA, Azam M, Pratama AD. Predictors of smear non-conversion among new-treatment pulmonary tuberculosis: a single center case-control study in Indonesia. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.204216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Previous studies concluded predictors of smear non-conversion pulmonary tuberculosis (TB) globally as well as in Indonesia. However, there is a limited data in hospital setting. This study aimed to explore predictors of smear non-conversion pulmonary TB in hospital setting.
METHODS A case-control study was conducted to explore predictors of smear nonconversion among new-treatment pulmonary TB in Dr. Kariadi General Hospital from 2017 to 2019. Number of cases and controls have been determined consecutively. Data were collected from secondary data accessed in medical records and directly from subjects. Non-conversion status in the case group was defined as a persistent sputum smear-positive after 2 months of intensive phase of treatment. The subjects’ characteristics i.e., age, sex, BMI, education level, occupational status, and predictors of smear non-conversion, i.e., patient’s compliance, smoking status, alcohol consumption, presence of drugs side effects, health care access, first acid-fast bacilli (AFB) smear grading, diabetes mellitus (DM), housing condition, housing density, and household income were observed. Chi-square test and binary logistic regression were used.
RESULTS 35 subjects were determined in the case group while 76 subjects were the control group and involved in the final analysis. Age, sex, first AFB smear grading, smoking status, housing condition, housing density, and DM were involved in the model of logistic regression. DM (OR = 3.4; 95% CI = 1.19–10.00) and first AFB smear grading (OR = 11.2; 95% CI = 3.86–33.00) were concluded as the predictors of smear nonconversion.
CONCLUSIONS DM and first AFB smear grading were the predictors of smear nonconversion among new-treatment pulmonary TB subjects.
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Izudi J, Tamwesigire IK, Bajunirwe F. Sputum smear non-conversion among adult persons with bacteriologically confirmed pulmonary tuberculosis in rural eastern Uganda. J Clin Tuberc Other Mycobact Dis 2020; 20:100168. [PMID: 32529053 PMCID: PMC7283142 DOI: 10.1016/j.jctube.2020.100168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rationale Failure to convert sputum at two months of treatment among persons with bacteriologically confirmed pulmonary tuberculosis (BC-PTB) indicates poor response to treatment but data are limited on its assessment. Objective We determined the frequency and factors associated with sputum smear non-conversion at two months among persons with BC-PTB in eastern Uganda. Methods We abstracted data of adult persons with BC-PTB, from routinely available records from TB registers at 10 clinics in eastern Uganda. We determined factors that are independently associated with sputum smear non-conversion using logistic regression analysis. We expressed the results as odds ratio (OR) with 95% confidence interval (CI). Measurements and main results Of 516 persons with BC-PTB, 81 (15.7%) did not achieve sputum smear conversion at two months of TB treatment. Higher Mycobacteria tuberculosis (MTB) load and treatment at a private-not-for-profit (PNFP) facility compared to government health facility were significantly associated with sputum smear non-conversion. A one unit (+1) increase in MTB load based on ZN stain counts was associated with a 48% increase in the odds of sputum smear non-conversion with adjusted odds ratio (AOR), 1.48 (95% CI, 1.02-2.18). TB treatment at private-not-for-profit health facility was associated with a two-fold increase in the odds of sputum smear non-conversion (AOR, 2.03; 95% CI, 1.01-3.92). Conclusions Our study shows that sputum smear non-conversion is common at two months of treatment in this population. It is more likely among patients with higher baseline MTB load and those treated at PNFP facilities. Strategies targeting patients with these risk factors are needed to enhance sputum smear conversion.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Imelda K Tamwesigire
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Francis Bajunirwe
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda
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Mlotshwa M, Abraham N, Beery M, Williams S, Smit S, Uys M, Reddy C, Medina-Marino A. Risk factors for tuberculosis smear non-conversion in Eden district, Western Cape, South Africa, 2007-2013: a retrospective cohort study. BMC Infect Dis 2016; 16:365. [PMID: 27484399 PMCID: PMC4971671 DOI: 10.1186/s12879-016-1712-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 07/11/2016] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) continues to be a major global health problem. While progress has been made to improve TB cure rates, South Africa’s 76 % smear-positive pulmonary TB (PTB) case cure rate remains below the WHO target of 85 %. We report on the trends of TB smear non-conversion and their predictors at the end of an intensive phase of treatment, and how this impacted on treatment outcomes of smear-positive PTB cases in Eden District, Western Cape Province, South Africa. Methods Routinely collected, retrospective data of smear-positive PTB cases from the electronic TB register in Eden District between 2007 and 2013 was extracted. Non-conversion was defined as persistent sputum smear-positive PTB cases at the end of the two or three month intensive phase of treatment. Chi-square test for linear trend and simple linear regression analysis were used to analyse the change in percentages and slope of TB smear non-conversion rates over time. Risk factors for TB non-conversion, and their impact on treatment outcomes, were evaluated using logistic regression models. Results Of 12,742 total smear-positive PTB cases included in our study, 12.8 % (n = 1627) did not sputum smear convert; 13.3 % (1411 of 10,574) of new cases and 9.9 % (216 of 2168) of re-treatment cases. Although not statistically significant in either new or re-treatment cases, between 2007 and 2013, smear non-conversion decreased from 16.4 to 12.7 % (slope = −0.60; 95 % CI: −1.49 to 0.29; p = 0.142) in new cases, and from 11.3 to 10.8 % in re-treatment cases (slope = −0.29; 95 % CI: −1.06 to 0.48; p = 0.376). Male gender, HIV co-infection and a >2+ acid fast bacilli (AFB) smear grading at the start of TB treatment were independent risk factors for non-conversion (p < 0.001). Age was a risk factor for non-conversion in new cases, but not for re-treatment cases. Non-conversion was also associated with unsuccessful treatment outcomes (p < 0.01), including treatment default and treatment failure. Conclusions Smear-positive PTB cases, especially men and those with identified risk factors for non-conversion, should be closely monitored throughout their treatment period. The South African TB control program should invest in patient adherence counselling and education to mitigate TB non-conversion risk factors, and to improve conversion and TB cure rates. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1712-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mandla Mlotshwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa.,Epidemiology Research Unit, Foundation for Professional Development, Pretoria, South Africa.,School of Health System and Public Health, University of Pretoria, Pretoria, South Africa
| | - Natasha Abraham
- Epidemiology Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Moira Beery
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Seymour Williams
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Sandra Smit
- Department of Health, George, Western Cape, South Africa
| | - Margot Uys
- Epidemiology Research Unit, Foundation for Professional Development, Pretoria, South Africa
| | - Carl Reddy
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Andrew Medina-Marino
- Epidemiology Research Unit, Foundation for Professional Development, Pretoria, South Africa. .,School of Health System and Public Health, University of Pretoria, Pretoria, South Africa.
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Honarvar MR, Eghtesadi S, Gill P, Jazayeri S, Vakili MA, Shamsardekani MR, Abbasi A. The effect of green tea extract supplementation on sputum smear conversion and weight changes in pulmonary TB patients: A randomized controlled trial. Med J Islam Repub Iran 2016; 30:381. [PMID: 27493925 PMCID: PMC4972068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 02/21/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acceleration in sputum smear conversion helps faster improvement and decreased probability of the transfer of TB. In this study, we aimed to investigate the effect of green tea extract supplementation on sputum smear conversion and weight changes in smear positive pulmonary TB patients in Iran. METHODS In this double blind clinical study, TB patients were divided into intervention, (n=43) receiving 500 mg green tea extract (GTE), and control groups (n=40) receiving placebo for two months, using balanced randomization. Random allocation and allocation concealment were observed. Height and weight were measured at the beginning, and two and six months post-treatment. Evaluations were performed on three slides, using the ZiehlNeelsen method. Independent and paired t test, McNemar's, Wilcoxon, Kaplan-Meier, Cox regression model and Log-Rank test were utilized. Statistical significance was set at p<0.05. This trial was registered under IRCT201212232602N11. RESULTS The interventional changes and the interactive effect of intervention on weight were not significant (p>0.05). In terms of shortening the duration of conversion, the case to control proportion showed a significant difference (p=0.032). Based on the Cox regression model, the hazard ratio of the relative risk of delay in sputum smear conversion was 3.7 (p=0.002) in the higher microbial load group compared to the placebo group and 0.54 (95% CI: 0.31-0.94) in the intervention compared to the placebo group. CONCLUSION GTE decreases the risk of delay in sputum smear conversion, but has no effect on weight gain. Moreover, it may be used as an adjuvant therapy for faster rehabilitation for pulmonary TB patients.
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Affiliation(s)
- Mohammad Reza Honarvar
- 1 PhD Candidate, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahryar Eghtesadi
- 2 Professor, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. ,(Corresponding author) Professor, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Pooria Gill
- 3 Assistant Professor, Departments of PhysioPharmacology & NanoBioMedicine, Research Center for Immunogenetics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Shima Jazayeri
- 4 Associate Professor, Research Center for Prevention of Cardiovascular Disease, Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. .
| | - Mohammad Ali Vakili
- 5 Associate Professor, Health Management and Social Development Research Center, Department of Health and Community Medicine, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
| | - Mohammad Reza Shamsardekani
- 6 Professor, Department of Pharmacognosy, Faculty of Pharmacy and Medicinal Plants Research Center, Tehran University of Medical Sciences, Tehran, Iran. .
| | - Abdollah Abbasi
- 7 Assistant Professor, Department of Infection, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran.
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Workneh MH, Bjune GA, Yimer SA. Diabetes mellitus is associated with increased mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients in South-Eastern Amahra Region, Ethiopia. Infect Dis Poverty 2016; 5:22. [PMID: 27009088 PMCID: PMC4806519 DOI: 10.1186/s40249-016-0115-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/14/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is growing evidence suggesting that diabetes mellitus (DM) affects disease presentation and treatment outcome in tuberculosis (TB) patients. This study aimed at investigating the role of DM on clinical presentations and treatment outcomes among newly diagnosed TB patients. METHODS A prospective cohort study was conducted in South-Eastern Amhara Region, Ethiopia from September 2013 till March 2015. Study subjects were consecutively recruited from 44 randomly selected health facilities in the study area. Participants were categorized into two patient groups, namely, patients with TB and DM (TBDM) and TB patients without DM (TBNDM). Findings on clinical presentations and treatment outcomes were compared between the two patient groups. Cox proportional hazard regression analysis was applied to identify factors associated with death. RESULTS Out of 1314 TB patients enrolled in the study, 109 (8.3 %) had coexisting DM. TBDM comorbidity [adjusted hazard ratio (AHR) 3.96; 95 % confidence interval (C.I.) (1.76-8.89)], and TB coinfection with human immunodeficiency virus (HIV) [AHR 2.59; 95 % C.I. (1.21-5.59)] were associated with increased death. TBDM and TBNDM patients did not show significant difference in clinical symptoms at baseline and during anti-TB treatment period. However, at the 2(nd) month of treatment, TBDM patients were more symptomatic compared to patients in the TBNDM group. CONCLUSIONS The study showed that DM is associated with increased death during TB treatment. DM has no association with clinical presentation of TB except at the end of the intensive phase treatment. Routine screening of TB patients for DM is recommended for early diagnosis and treatment of patients with TBDM comorbidity.
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Affiliation(s)
- Mahteme Haile Workneh
- />Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- />Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
| | - Gunnar Aksel Bjune
- />Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- />Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- />Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- />Department of Microbiology, Oslo University Hospital, Oslo, Norway
- />Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Fanai S, Viney K, Tarivonda L, Roseveare C, Tagaro M, Marais BJ. Profile of tuberculosis patients with delayed sputum smear conversion in the Pacific island of Vanuatu. Public Health Action 2015; 4:S19-24. [PMID: 26477281 DOI: 10.5588/pha.13.0075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/18/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING National tuberculosis control programme, Vanuatu. OBJECTIVE To assess tuberculosis (TB) trends, characterise sputum smear-positive patients with non-conversion at 2 months and assess their treatment outcomes. DESIGN Evaluation of programme data over a 9-year period (2004-2012), comparing 2-month sputum non-converters (delayed converters) with sputum smear converters diagnosed in 2011 and 2012. RESULTS Annual TB case numbers were similar over the study period, with an average TB notification rate of 58 per 100 000 population. Of 417 sputum smear-positive cases, 74 (18%) were delayed converters. Delayed converters were more likely than converters (88% vs. 79%) to have had high pre-treatment sputum smear grades (OR 2.5, 95%CI 0.97-6.45). Among delayed converters, treatment adherence was high (99% good adherence), outcomes were generally good (90% treatment success, 85% cure, 4% treatment failure) and no drug resistance was detected. Deaths were unexpectedly common among converters (11/80, 14%), with significantly more deaths in Tafea than in Shefa Province (7/58 vs. 2/80, OR 5.35, 95%CI 1.07-26.79). Tafea Province also had the greatest number of delayed converters (30/74, 40.5%) and the highest TB incidence rate. CONCLUSION Delayed sputum conversion was relatively uncommon, and was not associated with adverse outcomes or drug resistance. Regional differences require further investigation to better understand local factors that may compromise patient management.
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Affiliation(s)
- S Fanai
- National Tuberculosis Programme, Port Vila, Republic of Vanuatu
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - L Tarivonda
- Ministry of Health, Port Vila, Republic of Vanuatu
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - M Tagaro
- National Tuberculosis Programme, Port Vila, Republic of Vanuatu
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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Djouma FN, Noubom M, Ateudjieu J, Donfack H. Delay in sputum smear conversion and outcomes of smear-positive tuberculosis patients: a retrospective cohort study in Bafoussam, Cameroon. BMC Infect Dis 2015; 15:139. [PMID: 25884844 PMCID: PMC4381415 DOI: 10.1186/s12879-015-0876-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 03/10/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In limited resource settings, sputum smear conversion at the end of the intensive phase of tuberculosis treatment is an indicator not only of patients' response to treatment, but also of anti-tuberculosis program performance. The objective of this study was to identify factors associated to sputum smear non-conversion at the end of the intensive phase of treatment, and the effect of smear non-conversion on the outcome of smear-positive pulmonary tuberculosis patients. METHOD This retrospective cohort study was carried out on data of patients treated in the Diagnostic and Treatment Centre of Baleng, West-Cameroon from 2006 to 2012. Logistic regression models were used to evaluate the association of socio-demographic and clinical factors with delay in sputum smear conversion, and the association of this delay with treatment outcomes. RESULT Out of 1425 smear-positive pulmonary tuberculosis patients treated during the study period, 1286 (90.2%) were included in the analysis. Ninety four (7.3% CI: 6.0- 8.9) patients were identified as non-converted at the end of the intensive phase of treatment. Pre-treatment smears graded 2+ and 3+ were independently associated to delay in smear conversion (p<0.01). Years of treatment ranging from 2009 to 2012 were also associated to delay in smear conversion (p<0.02). Delay in smear conversion was significantly associated to failure [Adjusted Odd Ratio (AOR):12.4 (Confidence Interval: CI 4.0- 39.0)] and death, AOR: 3.6 (CI 1.5- 9.0). CONCLUSION Heavy initial bacillary load and treatment years ranging from 2009 to 2012 were associated to sputum smear non-conversion at the end of the intensive phase of TB treatment. Also, delay in smear conversion was associated to unfavorable treatment outcomes. Patients with heavy initial bacillary load should thus be closely monitored and studies done to identify reasons for the high proportion of non-conversion among patients treated between 2009 and 2012.
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Affiliation(s)
- Fabrice Nembot Djouma
- Department of Biomedical Sciences, University of Dschang, Cameroon, PO Box 067, Dschang, Cameroon.
- Better Access to Health Care "MASSANTE", PO Box 33490, Yaoundé, Cameroon.
| | - Michel Noubom
- Department of Biomedical Sciences, University of Dschang, Cameroon, PO Box 067, Dschang, Cameroon.
- Diagnostic and Treatment Centre of Baleng, Bafoussam, Cameroon.
| | - Jérôme Ateudjieu
- Department of Biomedical Sciences, University of Dschang, Cameroon, PO Box 067, Dschang, Cameroon.
- Better Access to Health Care "MASSANTE", PO Box 33490, Yaoundé, Cameroon.
- Division of Health Operations Research, Ministry of Public Health, Cameroon, PO Box 33490, Yaoundé, Cameroon.
| | - Hubert Donfack
- Department of Biomedical Sciences, University of Dschang, Cameroon, PO Box 067, Dschang, Cameroon.
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Ukwaja KN, Oshi DC, Oshi SN, Alobu I. Profile and treatment outcome of smear-positive TB patients who failed to smear convert after 2 months of treatment in Nigeria. Trans R Soc Trop Med Hyg 2014; 108:431-8. [PMID: 24846911 DOI: 10.1093/trstmh/tru070] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In Nigeria, little is known about the profile and treatment outcomes of smear-positive pulmonary TB (SPPTB) patients with persistent smear positivity after 2 months of treatment. METHODS A retrospective cohort study was carried out to determine the characteristics and treatment outcomes of patients with persistent smear positivity after 2 months of treatment among adults with SPPTB between 2011 and 2012 in two large health facilities in Nigeria. Findings were compared with SPPTB patients who had a negative smear conversion in the same period. RESULTS Of 929 eligible patients, 187 (20.1%) had persistent smear positivity after 2 months of treatment. Independent predictors for persistent smear positivity were older age (p<0.001) and care at a public facility (p<0.001). Patients with persistent smear positivity had a higher proportion of unsuccessful treatment outcomes compared with those with a negative smear conversion (21.9% vs 12.4%; p<0.001), mainly due to treatment failure (p<0.001). Across treatment category (new versus previously treated cases), age group and residence category (urban versus rural), rates of unsuccessful outcomes were significantly higher among patients with persistent smear positivity. CONCLUSION Treatment outcomes of SPPTB patients with persistent smear positivity were inferior to those who smear converted, with treatment failure being a major problem. This needs to be urgently addressed by the National Tuberculosis Control Programme.
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Affiliation(s)
- Kingsley N Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Daniel C Oshi
- Centre for Development and Reproductive Health, Enugu, Nigeria
| | - Sarah N Oshi
- Centre for Development and Reproductive Health, Enugu, Nigeria
| | - Isaac Alobu
- National Tuberculosis and Leprosy Control Programme, Ministry of Health, Abakaliki, Ebonyi State, Nigeria
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