Department of Medicine, Department of Global Health, University of Washington, 325 Ninth Ave, Box 359909, Seattle, WA 98104, United States; Department of Global Health, University of Washington, Seattle, WA, United States; Tuberculosis Control Program, Department of Public Health, Seattle and King County, Seattle, WA, United States; Department of Epidemiology, University of Washington, Seattle, WA, United States; School of Medicine, University of Washington, Seattle, WA, United States; Pomona College, Claremont, CA, United States; Coast Provincial General Hospital, Mombasa, Kenya; Center for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya; Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Public Health and Sanitation, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, WA, United States; Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
Arentz, M., Department of Medicine, Department of Global Health, University of Washington, 325 Ninth Ave, Box 359909, Seattle, WA 98104, United States; Narita, M., Department of Medicine, Department of Global Health, University of Washington, 325 Ninth Ave, Box 359909, Seattle, WA 98104, United States, Department of Global Health, University of Washington, Seattle, WA, United States, Tuberculosis Control Program, Department of Public Health, Seattle and King County, Seattle, WA, United States; Sangaré, L., Department of Epidemiology, University of Washington, Seattle, WA, United States; Kah, J.F., School of Medicine, University of Washington, Seattle, WA, United States; Low, D., Pomona College, Claremont, CA, United States; Mandaliya, K., Coast Provincial General Hospital, Mombasa, Kenya; Amukoye, E., Center for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya; Sitienei, J., Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Public Health and Sanitation, Nairobi, Kenya; Walson, J.L., Department of Medicine, Department of Global Health, University of Washington, 325 Ninth Ave, Box 359909, Seattle, WA 98104, United States, Department of Global Health, University of Washington, Seattle, WA, United States, Department of Epidemiology, University of Washington, Seattle, WA, United States, Department of Pediatrics, University of Washington, Seattle, WA, United States, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
SETTING: Tuberculosis (TB) treatment center at Coast Provincial General Hospital in Mombasa, Kenya. OBJECTIVES: To describe TB management practices in a facility in coastal Kenya and identify factors associated with poor treatment outcomes. DESIGN: Retrospective review of patient treatment records from January 2008 to June 2009. Treatment outcomes of patients were classified as treatment success (cure or treatment completion) or poor treatment outcome (treatment failure, death or default). Relative risk regression was used to determine the association between exposures of interest and poor treatment outcomes. RESULTS: Records were obtained from a total of 183 patients: 142 (78%) had pulmonary TB, 68 (37%) were human immunodeficiency virus (HIV) infected and 81 (44%) had acid-fast bacilli (AFB) positive smear microscopy. Most treated individuals (86%) achieved a successful treatment outcome as defined by the World Health Organization. Of those with poor treatment outcomes, 64% defaulted, 32% died, and 4% failed treatment. Initial negative AFB smear and HIV co-infection were associated with poor treatment outcomes (RR 3.32, 95%CI 1.22-8.99 and RR 4.61, 95%CI 1.69-12.59, respectively). CONCLUSION: Strategies to accelerate accurate diagnosis of smear-negative TB and increase patient retention during treatment, especially in HIV co-infected individuals, are needed to reduce poor treatment outcomes in Kenya. © 2011 The Union.
