title: Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya.
abstract: OBJECTIVE
  To determine gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya.
  
  
  METHODS
  Retrospective descriptive cohort.
  
  
  RESULTS
  Of 16 056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%, P < 0.001; adjusted OR 1.29, 95%CI 1.16-1.44, P < 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86-1.13, P = 0.844). In the model restricted to HIV-negative patients, a non-significantly lower risk was found (OR 0.89, 95%CI 0.73-1.09, P = 0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84-1.14, P = 0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79-1.67, P = 0.461).
  
  
  CONCLUSIONS
  Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: R J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: Ministry of Health, Department of Disease Prevention and Control, Nairobi, Kenya; Moi University Department of Epidemiology, Nairobi Campus, Nairobi, Kenya.
authors.forename: J K
authors.initials: JK
authors.lastname: Sitienei
authors.affiliation: World Health Organization, Nairobi, Kenya.
authors.forename: H
authors.initials: H
authors.lastname: Kipruto
authors.affiliation: Division of Leprosy Tuberculosis and Lung Disease, Ministry of Health, Nairobi, Kenya.
authors.forename: K
authors.initials: K
authors.lastname: Kimenye
authors.affiliation: Ruby Medical Centre, Kiambu West, Kenya.
authors.forename: D
authors.initials: D
authors.lastname: Gathara
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: F X
authors.initials: FX
authors.lastname: Odawa
authors.affiliation: Department of Human Anatomy, University of Nairobi, Nairobi, Kenya, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Gichangi
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Callens
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Department of Health Management, Moi University, Eldoret, Kenya.
authors.forename: J C
authors.initials: JC
authors.lastname: Sitienei
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: A-B
authors.initials: AB
authors.lastname: Kihara
authors.affiliation: Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors.forename: E-J
authors.initials: EJ
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents