title: Anemia at the initiation of tuberculosis therapy is associated with delayed sputum conversion among pulmonary tuberculosis patients in Dar-es-Salaam, Tanzania.
abstract: BACKGROUND
  Pulmonary tuberculosis and anemia are both prevalent in Tanzania. There is limited and inconsistent literature on the association between anemia and sputum conversion following tuberculosis treatment.
  
  
  METHODS
  Newly diagnosed sputum smear positive pulmonary tuberculosis patients aged ≥15 years initiating on standard anti tuberculosis therapy were recruited from 14 of 54 tuberculosis clinics in Dar es Salaam. Patients were receiving medication according to the recommended short course Directly Observed Therapy (DOT) strategy and were followed up prospectively until completion of treatment (six months). Patients were evaluated before initiation of TB treatment by performing the following; clinical history, physical examination, complete blood counts, serum biochemistry and sputum microscopy. Sputum smears were re-examined at two months of anti-tuberculosis therapy for presence of acid fast bacilli. Anemia was defined as hemoglobin <13 g/dl (males) or <12 g/dl (females). Log-binomial regression was used to assess the association between anemia and sputum conversion at two months.
  
  
  RESULTS
  Of the 1245 patients included in the study, 86% were anemic and 7% were sputum smear positive at two months of anti-tuberculosis therapy. Anemic patients were three times more likely to have sputum positive smear as compared to non-anemic patients at two months (RR = 3.05; 95% CI 1.11-8.40) p = 0.03. The risk for sputum positive smear results increased with severity of anemia (P for trend <0.01).
  
  
  CONCLUSIONS
  Baseline anemia is associated with increased risk for persistent positive sputum smears at two months of tuberculosis treatment. Future studies should evaluate the mechanisms for TB-associated anemia as well as the role of intervention for anemia among TB patients.
authors.affiliation: Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar- es- Salaam, Tanzania; Department of Laboratory Medicine, Karolinska Institutet (KI), Stockholm, Sweden.
authors.forename: Tumaini J
authors.initials: TJ
authors.lastname: Nagu
authors.affiliation: Department of Epidemiology, Harvard School of Public Health (HSPH), Boston, Massachusetts, United States of America; Department of Biostatistics, Harvard School of Public Health (HSPH), Boston, Massachusetts, United States of America.
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.affiliation: Department of Epidemiology, Harvard School of Public Health (HSPH), Boston, Massachusetts, United States of America.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.affiliation: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.affiliation: Department of Hematology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar- es- Salaam, Tanzania.
authors.forename: Julie
authors.initials: J
authors.lastname: Makani
authors.affiliation: Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
authors.forename: Mecky I
authors.initials: MI
authors.lastname: Matee
authors.affiliation: Department of Global Health and Population, Harvard School of Public Health (HSPH), Boston, Massachusetts, United States of America.
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
authors.affiliation: Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar- es- Salaam, Tanzania.
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Mugusi
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000502:physiology; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D013636:Tanzania; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents