title: Documentation and treatment outcomes of smear-negative and extra-pulmonary tuberculosis in Ethiopia.
abstract: BACKGROUND
  Smear-negative and extra-pulmonary tuberculosis (TB) comprise two thirds of TB cases reported in Ethiopia. Neither treatment outcomes nor underlying associated factors are routinely reported for these cases.
  
  
  OBJECTIVE
  To assess treatment outcomes and associated risk factors of smear-negative and extra-pulmonary TB in comparison with smear-positive cases.
  
  
  METHODS
  Record review of all TB cases registered in 14 randomly selected public and private health facilities in Addis Ababa, Ethiopia, over a 1-year period.
  
  
  RESULTS
  Percentages of smear-negative and extra-pulmonary TB were independent of human immunodeficiency virus (HIV) status, and were not evenly distributed among health facilities. Extra-pulmonary TB was overrepresented in the private sector, and smear-negative TB was more frequent in health clinics than in hospitals. Outcomes reported by clinics were more favourable than those of the hospitals; no differences were observed when comparing public and private health facilities. Only 54% of the TB registers were complete; missing information correlated with unfavourable outcomes. Younger age, but not sex or HIV status, was associated with favourable outcomes.
  
  
  CONCLUSIONS
  The uneven distribution of smear-negative and extra-pulmonary TB among different health facilities requires further study and may provide important insight into diagnosis and care of these patients. Incomplete TB register information may be an underappreciated factor contributing to unfavourable outcomes.
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: F
authors.initials: F
authors.lastname: Tesgaye
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Defar
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: T
authors.initials: T
authors.lastname: Beyene
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: O
authors.initials: O
authors.lastname: Shafi
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, The Netherlands ; Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Klinkenberg
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: R
authors.initials: R
authors.lastname: Howe
keywords: Africa; cohort analysis; recording and reporting