title: Tuberculosis diagnosed in a rural setting in Angola. Accuracy of follow-up sputum smears to predict outcome.
abstract: OBJECTIVE
  To analyze treatment outcome and the accuracy of positive sputum smear at 2 months to predict treatment failure in a cohort of patients with tuberculosis (TB) in a rural setting in Angola.
  
  
  METHODS
  Observational study of patients with TB from January 2009  to August 2010 in Hospital Nossa Senhora da Paz in Angola. A multivariate analysis was performed to identify variables associated with treatment failure and death. Sensitivity, specificity, positive and negative predictive values and likelihood ratios to define the accuracy of a positive sputum  smear at 2 months to predict treatment failure were calculated.
  
  
  RESULTS
  One thousand four hundred and twenty-five patients were diagnosed with TB. Overall, 526 patients were cured from TB and 419 had treatment completed, so 945 (66·3%) patients achieved treatment success.  The outcomes of the remaining patients were: 91 (6·4%) had treatment failure, 100 (7%) died, 49 (3·4%) interrupted treatment, and 240 (16·8%) were transferred out. Variables associated with a higher risk of treatment failure were previously treated patients (odds ratio,  2·36; 95% confidence interval, 1·32-4·2) and positive sputum smear at 2 months (odds ratio, 9·81; 95% confidence interval, 5·88-16·36). Among the group of 551 patients with sputum smear confirmed at diagnosis and specimens taken at 2  and 5 months, the positive predictive value (31%) and the positive likelihood ratio (3·21) of a positive sputum smear taken at 2 months to predict treatment failure were low.
  
  
  CONCLUSIONS
  Patients with positive sputum smear at 2 months have a higher risk of treatment failure.  However, this by itself is a poor predictor of treatment failure.
authors: Hospital Nossa Senhora da Paz de Cubal, Angola.
authors: Teresa
authors: T
authors: López
authors: Milagros
authors: M
authors: Moreno
authors: Fernando
authors: F
authors: Salvador
authors: Adriano
authors: A
authors: Zacarías
authors: Rosa de
authors: Rd
authors: Carvalho
authors: Estevao
authors: E
authors: Tomás
authors: Gabriel
authors: G
authors: Estevao
authors: Arlette Nindia
authors: AN
authors: Eugenio
authors: Joaquin
authors: J
authors: Burgos
authors: Elena
authors: E
authors: Sulleiro
authors: Israel
authors: I
authors: Molina
authors: Vicenç
authors: V
authors: Falcó
mesh_terms: D000293:Adolescent; D000328:Adult; D000810:Angola; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012424:Rural Population; D013183:Sputum / Q000382:microbiology*; D017211:Treatment Failure; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents