Prevalence and Risk Factors of Delayed Sputum Conversion among Patients Treated for Smear Positive PTB in Northwestern Rural Tanzania: A Retrospective Cohort Study

Abstract

Introduction Smear positive TB carries high morbidity and mortality. The TB treatment aims at sputum conversion by two months of antituberculous. Patients who delay sputum conversion remain potentially infectious, with risk of treatment failure, drug resistance, and mortality. Little is known about the magnitude of this problem in our setting. This study was designed to determine the prevalence and risk factors of delayed sputum conversion in northwestern rural part of Tanzania. Methods This was a retrospective cohort study involving smear positive TB patients at Sengerema DDH in 2015. Demographic data, HIV status, and sputum results at TB diagnosis and on TB treatment were collected and analyzed using STATA 11. Results In total, 156 patients were studied. Males were 97 (62%); the median age was 39 [30–51] years. Fifty-five (35.3%) patients were HIV coinfected and 13 (8.3%) patients had delayed sputum conversion which was strongly associated with male gender (OR = 8.2, p = 0.046), age >50 years (OR = 6.7, p = 0.003), and AFB 3+ (OR = 8.1, p = 0.008). Conclusions Delayed sputum conversion is prevalent in this study. These patients can potentially fail on treatment, develop drug resistance, and continue spreading TB. Strategies to reduce the rate of delayed sputum conversion could also reduce these potential unfavorable outcomes.

Longitudinal body weight and sputum conversion in patients with tuberculosis, Southwest Ethiopia: a retrospective follow-up study

“…Among patients with TB who were taking anti-TB drugs, delayed sputum conversion was associated with old age. 28 29 A study identified age-related decline in T cell immune responses, which was linked to increased risk of TB infection. Furthermore, other factors such as age-related diseases, including malignancy, diabetes mellitus, poor nutrition and immunosuppression, contribute to increased risk of TB in the old age segment of the population.…”

Factors associated with sputum conversion in a multinational population of tuberculosis patients

“…D 'Souza et al (2018) in Pakistani patients describe conversion of 91.5% in new TB patients 2 . Other studies describe sputum conversion of 91.7% (Rural Tanzania) (Gunda, 2017), 91.9% (Ghana) (Acquah, 2015) and 91.0% (India) (Tahir, 2006).…”

“…The association of older age and high sputum grade with delayed conversion was described in a tertiary care facility in Pakistan (D'Souza et al, 2018) and Tanzania (Gunda, 2017). In a large cohort of smear-positive TB cases attended to in Eden Province (South Africa), those with more than 30 years old and high bacillary load had an increased probability for non-conversion (Mlotshwa et al, 2016).…”

“…The conversion time has been related with multiple factors including nutritional factors such as anemia, magnesium level, and body mass index (Bhargava et al, 2013;Putri et al, 2014;Agrawal, 2017), history of diabetes mellitus and poor metabolic control (Mi et al, 2013;Nakamura et al, 2014;Sharif, 2015), bacillary load in the diagnosis (D'Souza et al, 2018;Kanda et al, 2015;Gunda, 2017), diagnosis delay and radiological lesions suggestive of extensive damage or cavitation (Mi et al, 2013;Nakamura et al, 2014;Unsematham and Kateruttanakul, 2013;Visser et al, 2012) and drug resistance (Kim et al, 2016;Holtz et al, 2006;Kurbatova et al, 2012). A previously published paper identifies the bacillary load in the diagnosis as the main factor related with sputum conversion in patients attended to in a community hospital in Qatar, but the study is limited by the number of patients studied (64 patients) (Guanche et al, 2016).…”

Faktor Risiko Gagal Konversi BTA pada Pasien Tuberkulosis Paru Fase Intensif di Kota Yogyakarta

“…2 Penelitian yang dilakukan di Kameron, Tanzania dan Afrika Selatan mengidentifikasi pada pasien dengan umur yang lebih tua berisiko untuk gagal konversi dibandingkan pada pasien dengan umur yang lebih muda. 9,10,15,16 Beberapa penelitian lain menunjukkan tidak ada hubungan usia yang lebih tua dengan gagal konversi setelah pengobatan 2 bulan. [17][18][19] Dengan meningkatnya umur pasien, kemungkinan dalam mencari perawatan dan diagnosis menjadi terlambat sehingga penyakit akan berkembang biak.…”