title: Impact of smear microscopy results and observed therapy on tuberculosis treatment in Mombasa, Kenya.
abstract: METHODS
  Tuberculosis (TB) treatment center at Coast Provincial General Hospital in Mombasa, Kenya.
  
  
  OBJECTIVE
  To describe TB management practices in a facility in coastal Kenya and identify factors associated with poor treatment outcomes.
  
  
  METHODS
  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 micros- copy. 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).
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine, University of Washington, Seattle, Washington 98104, USA. marentz@u.washington.edu
authors: M
authors: M
authors: Arentz
authors: M
authors: M
authors: Narita
authors: L
authors: L
authors: Sangaré
authors: J F
authors: JF
authors: Kah
authors: D
authors: D
authors: Low
authors: K
authors: K
authors: Mandaliya
authors: E
authors: E
authors: Amukoye
authors: J
authors: J
authors: Sitienei
authors: J L
authors: JL
authors: Walson
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents