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Open Access Research article

Sputum completion and conversion rates after intensive phase of tuberculosis treatment: an assessment of the Rwandan control program

Felix R Kayigamba1*, Mirjam I Bakker2, Veronicah Mugisha3, Michel Gasana4 and Maarten F Schim van der Loeff56

Author Affiliations

1 INTERACT, CPCD, PO Box 2181, Kigali, Rwanda

2 Royal Tropical Institute, KIT Biomedical Research, Mauritskade 63, 1092 AD, Amsterdam, Netherlands

3 ICAP, Mailman School of Public Health, Columbia University, P.O. Box 3989, Kigali, Rwanda

4 Rwanda National TB Control Program (PNILT), Ministry of Health, P.O. Box 84, Kigali, Rwanda

5 Center for poverty-related communicable diseases (CPCD) and Center for Infection and Immunity Amsterdam (CINIMA), AMC, P.O. Box 22700, 1100 DE, Amsterdam, Netherlands

6 Public Health Service of Amsterdam (GGD), P.O. Box 2200, 1000 CE, Amsterdam, Netherlands

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BMC Research Notes 2012, 5:357  doi:10.1186/1756-0500-5-357

Published: 16 July 2012



In Rwanda tuberculosis (TB) is one of the major health problems. To contribute to an improved performance of the Rwandan National TB Control Program, we conducted a study with the following objectives: (1) to assess the completion rate of sputum smear examinations at the end of the intensive phase of TB treatment; (2) to assess the sputum conversion rate (SCR); (3) to assess associations between smear completion rate or SCR with key health facility characteristics.


TB registers in 89 health facilities in five provinces were reviewed. Data of new and retreatment smear-positive pulmonary TB (PTB+) cases registered between January and June 2006 were included in the study. Data on key characteristics of the selected health facilities were also collected.


Among 1509 new PTB + cases, 32 (2.1%) had died by 2 months, and 178 (11.8%) had been transferred-out. Among the remaining 1299 patients, a smear examination at month 2 was done in 1039 (smear completion rate 80.0%). Among these 1039, 852 (82.0%) had become smear-negative. The smear completion rate and SCR varied considerably between health facilities. A high number of new PTB cases at a health facility was the only significant predictor of a low completion rate, while the only independent factor associated with low sputum conversion rates was rural (vs. urban) location of the health facility.


In Rwanda, too few patients get a smear examination after 2 months of TB treatment; the SCR among those with smear results was adequate at 82%. A high number of new TB patients at a health facility was a significant predictor of a low completion rate. The national TB control program should design strategies to improve completion rates.

Sputum smear examination; Mycobacterium tuberculosis; Pulmonary tuberculosis; Africa