Determinants of persistent sputum smear positivity after intensive phase chemotherapy among patients with tuberculosis at Rhodes clinic, Nairobi, Kenya

Abstract

Tuberculosis is a global health challenge that according to World Health Organization (WHO) resulted in the deaths of 1.6 million people including 230,000 children in year 2017. (WHO, 2017). Sputum smear testing is recommended procedure for effective monitoring TB treatment success, with negative sputum testing results being the key signifier of successful treatment. Conversely, positive sputum smear results are an indicator of failure of treatment. This study was conducted to determine the factors that contribute to persistent sputum smear positivity after intensive treatment. The study took place at the Rhodes Clinic, Nairobi, a health facilities operated by the Department of Health (City county of Nairobi) and National Ministry of Health to primarily treat tuberculosis and lung diseases as well as acquired immune efficiency disease (AIDS). This case control study compared patients who were sputum positive (cases) to those who were sputum negative (controls) after completion of two months of intensive chemotherapy with TB medication. The sample population was 71, 25 of whom were cases and 46 were controls. Data was collected analyzed and results tabulated using SPSS. Skipping medication doses which is treatment non adherence was significantly associated with sputum positivity (p=0.01). Also, treatment practices were found to affect treatment outcome in that patients who were sputum positive at the end of the two-month period were more likely to have taken longer before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 -12) and 4 (3 – 8) weeks respectively. Similarly, patients who took longer to seek treatment were significantly more likely to miss their medicine. The study concluded that factors such as non-adherence to medication, and delayed diagnosis, and socio-economic factors contributed to persistent sputum positivity two months after intensive treatment.