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Journal of Medical and Biomedical Sciences

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Trends in sputum smear conversion among smear-positive pulmo-nary tuberculosis patients

SEK Acquah, L Quaye, W Walana, EK Vicar, YN Osei, C Amedor, AI Yahaya, JB Ziem

Abstract


Sputum smear conversion during pulmonary tuberculosis treatment is an important indicator of patient response to therapy and as such determines the direction of TB patient care. This retro-spective review assessed the trends in sputum smear evaluation and conversion rates among follow up pulmonary tuberculosis patients presenting to the Tamale Teaching Hospital from January 2004 to December 2012. A total of 8,238 sputum smear cases comprising of 6,892 (83.7%) diagnoses and 1,346 (16.3%) follow-up cases were recorded. The 1,346 follow-up cases comprised of 57.8% (778/1346) males and 42.2% (568/1346) females. The percentage proportion of follow up cases that had their month of follow up, residential addresses, ages and smear results reported are 93.8% (1262/1346), 95.2% (1281/1346), 98.2% (1322/1346) and 97.8% (1309/1346) respectively. The cumula-tive median age was 43years (IQR: 30 to 55years) with the minimum and maximum ages being 14 and 80 years recorded in 2008 and 2012 respectively. Thirty eight percent (511/1,346) of follow-up cases were from the intensive phase (month 2) evaluation period. One hundred and eleven (111) of the follow up cases were smear positive representing a cumulative positivity rate of 8.5% (111/1309). This comprised of 75(67.6 %) males and 36(32.4%) females. Generally males were observed to be significantly more likely to delay smear conversion during treatment (OR = 1.560; p = 0.035, 95% CI=1.032- 2.359) compared to females. The ages of the positive cases ranged from 14 to 75 years with a median age of 45.5 years. The intensive phase (month 2) positivity rate was 8.1% (63/776) representing a conversion rate of 91.9%. Significant proportion (15.4%) of males were smear posi-tive and were more likely to remain positive after two months of therapy compared to their female counterparts (OR = 2, p = 0.02, CI = 0.098 – 1.299). Periodic surveillance of regional sputum smear late/non conversion among PTB patients on treatment would be useful in supporting Tb manage-ment in Ghana.

Keywords: Mycobacterium tuberculosis, follow up, microscopy, acid fast bacilli, Ghana



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