title: Incomplete sputum smear microscopy monitoring among smear-positive tuberculosis patients in Uganda.
abstract: METHODS
  All 11 tuberculosis (TB) diagnostic and treatment units in Kyankwanzi and Kiboga Districts in Uganda.
  
  
  OBJECTIVE
  To determine the frequency of, factors associated with and barriers related to incomplete anti-tuberculosis treatment sputum monitoring.
  
  
  METHODS
  Data were abstracted from anti-tuberculosis treatment and laboratory registers of sputum smear-positive patients who started treatment between January 2009 and December 2011 in the study districts. Patients missing documentation for any smear results at 2 or 3, 5, and 6 or 8 months were classified as having incomplete monitoring. Health providers and patients were interviewed about barriers to sputum monitoring.
  
  
  RESULTS
  Overall, 272 (55%) of 492 patients had incomplete monitoring: 16% (78/492) at 2 or 3 months, 39% (181/465) at 5 months and 28% (119/428) at 6 or 8 months of treatment. More sputum results were recorded in laboratory than in TB treatment registers. Incomplete monitoring was significantly associated with being male, living in Kyankwanzi District and not receiving directly observed treatment. Patients' inability to produce sputum, long laboratory waiting times, and insufficient patient and provider education were primary reasons for incomplete monitoring.
  
  
  CONCLUSIONS
  Over half of patients missed at least one smear result during treatment, which has implications for treatment monitoring and treatment outcomes in Uganda.
authors.affiliation: Kyankwanzi District, Uganda National TB and Leprosy Programme, Butemba Town, Uganda.
authors.forename: P
authors.initials: P
authors.lastname: Nakaggwa
authors.affiliation: US Centers for Disease Control and Prevention (CDC), Entebbe, Uganda.
authors.forename: R
authors.initials: R
authors.lastname: Odeke
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Makerere College of Health Sciences, Kampala, Uganda.
authors.forename: B J
authors.initials: BJ
authors.lastname: Kirenga
authors.affiliation: CDC, Atlanta, Georgia, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bloss
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001431:Bacteriological Techniques; D002648:Child; D002675:Child, Preschool; D023801:Directly Observed Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000382:microbiology*; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification*; D010349:Patient Compliance; D011237:Predictive Value of Tests; D012042:Registries; D012111:Residence Characteristics; D012189:Retrospective Studies; D019035:Rural Health Services; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014454:Uganda; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents