Predictors of delayed sputum smear conversion among pulmonary tuberculosis patients in Kota Kinabalu, Malaysia

Abstract

Smear-positive pulmonary tuberculosis (SPPTB) is the major contributor to the spread of tuberculosis (TB) infection, and it creates high morbidity and mortality worldwide. The objective of this study was to determine the predictors of delayed sputum smear conversion at the end of the intensive phase of TB treatment in Kota Kinabalu, Malaysia.This retrospective study was conducted utilising data of SPPTB patients treated in 5 TB treatment centres located in Kota Kinabalu, Malaysia from 2013 to 2018. Pulmonary TB (PTB) patients included in the study were those who had at least completed the intensive phase of anti-TB treatment with sputum smear results at the end of the 2nd month of treatment. The factors associated with delayed sputum smear conversion were analyzed using multiple logistic regression analysis. Predictors of sputum smear conversion at the end of intensive phase were evaluated.A total of 2641 patients from the 2013 to 2018 periods were included in this study. One hundred eighty nine (7.2%) patients were identified as having delayed sputum smear conversion at the end of the intensive phase treatment. Factors of moderate (advanced odd ratio [aOR]: 1.7) and advanced (aOR: 2.7) chest X-ray findings at diagnosis, age range of >60 (aOR: 2.1), year of enrolment 2016 (aOR: 2.8), 2017 (aOR: 3.9), and 2018 (aOR: 2.8), smokers (aOR: 1.5), no directly observed treatment short-course (DOTS) supervisor (aOR: 6.9), non-Malaysian citizens (aOR: 1.5), and suburban home locations (aOR: 1.6) were associated with delayed sputum smear conversion at the end of the intensive phase of the treatment.To improve sputum smear conversion success rate, the early detection of PTB cases has to be fine-tuned so as to reduce late or severe case presentation during diagnosis. Efforts must also be in place to encourage PTB patients to quit smoking. The percentage of patients assigned with DOTS supervisors should be increased while at the same time ensuring that vulnerable groups such as those residing in suburban localities, the elderly and migrant TB patients are provided with proper follow-up treatment and management. Abbreviations: 95% CI = 95% confidence interval, AFB = acid fast bacilli, aOR = advanced odd ratio, DOTS = directly observed treatment short-course, EPTB = extrapulmonary tuberculosis, Mtb = Mycobacterium tuberculosis, PTB = pulmonary tuberculosis, SPPTB = smear-positive pulmonary tuberculosis, TB = tuberculosis, TBTC = tuberculosis treatment centres.

Prevalence and associated factors of delayed sputum smear conversion in patients treated for smear positive pulmonary tuberculosis: A retrospective follow up study in Sabah, Malaysia

“…Table 4 outlines the comparison of our prevalence data with a few recent studies in the past five years. Our finding is consistent with another Malaysian study which was also conducted in Sabah in different research sites, where they identified 7.2% of patients having delayed sputum conversion from 2013 to 2018 [ 14 ]. In comparison, our prevalence of delayed sputum conversion was not too high.…”

“…Ibrahim (2022) and Bhatti (2021) reported a higher prevalence of 19.1% and 30.5% respectively in Malaysia [ 15 , 16 ]. Similar large variation of prevalence data was observed globally as observed in Table 4 (8.3% to 35%), and as reported in earlier studies, from 8% in Cameroon up to 30% in Cleveland [ 14 – 21 ]. This variation is observed despite the relatively standardized, effective first-line regime for antituberculous therapy worldwide.…”

“…In our study, we also included foreigners in our analysis. We found that foreigners in the state of Sabah were more likely to have delayed sputum conversion, similar to Mokti et al [ 14 ]. The social demography in the state of Sabah is peculiar and different from the rest of Malaysia as they are known to have more foreigners.…”

Sputum Smear Non-conversion at the End of Intensive Phase of Tuberculosis Treatment at a Tertiary Center: A Descriptive Cross-sectional study

“…8,9 The percentage of smear-positive patients with delayed sputum smear conversion at the end of the intensive phase of anti-TB treatment is an indicator of the performance of the TB programme. 10 Thus, it is necessary to study the sputum non-conversion rates in different settings. In addition, a detailed study is necessary to be carried out to stratify the role of these factors.…”

“…8,9 Sputum non-conversion rates have been increasingly observed during the management of TB patients. 10 No significant study has been performed in recent years in Nepal to find out the prevalence of sputum JNMA I VOL 59 I ISSUE 243 I November 2021 non-conversion in patients undergoing anti-tubercular therapy and to stratify the role of various causes that might have contributed to the development of nonconversion.…”