Sputum completion and conversion rates after intensive phase of tuberculosis treatment: an assessment of the Rwandan control program

• Published in: BMC research notes Vol. 5; no. 1; p. 357
• Main Authors: Kayigamba, Felix R, Bakker, Mirjam I, Mugisha, Veronicah, Gasana, Michel, Schim van der Loeff, Maarten F
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.07.2012; BioMed Central; BMC
• Subjects: Africa; Antitubercular Agents - pharmacology; Antitubercular Agents - therapeutic use; Biomedical research; Care and treatment; Control; Data collection; Diagnosis; Diagnostic specimens; Health Facilities; Humans; Mycobacterium; Mycobacterium tuberculosis; Pulmonary tuberculosis; Retreatment; Rwanda - epidemiology; Sputum - drug effects; Sputum - microbiology; Sputum smear examination; Statistical analysis; Statistics; Studies; Treatment Outcome; Tuberculosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - prevention & control; Rwanda
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/1756-0500-5-357

In Rwanda tuberculosis (TB) is one of the major health problems. To contribute to an improved performance of the Rwandan National TB Control Program, we conducted a study with the following objectives: (1) to assess the completion rate of sputum smear examinations at the end of the intensive phase of TB treatment; (2) to assess the sputum conversion rate (SCR); (3) to assess associations between smear completion rate or SCR with key health facility characteristics. TB registers in 89 health facilities in five provinces were reviewed. Data of new and retreatment smear-positive pulmonary TB (PTB+) cases registered between January and June 2006 were included in the study. Data on key characteristics of the selected health facilities were also collected. Among 1509 new PTB + cases, 32 (2.1%) had died by 2 months, and 178 (11.8%) had been transferred-out. Among the remaining 1299 patients, a smear examination at month 2 was done in 1039 (smear completion rate 80.0%). Among these 1039, 852 (82.0%) had become smear-negative. The smear completion rate and SCR varied considerably between health facilities. A high number of new PTB cases at a health facility was the only significant predictor of a low completion rate, while the only independent factor associated with low sputum conversion rates was rural (vs. urban) location of the health facility. In Rwanda, too few patients get a smear examination after 2 months of TB treatment; the SCR among those with smear results was adequate at 82%. A high number of new TB patients at a health facility was a significant predictor of a low completion rate. The national TB control program should design strategies to improve completion rates.