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 socioeconomic factors contributed to persistent sputum positivity two months after
intensive treatment.
