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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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords:
Sputum smear examination; Mycobacterium tuberculosis; Pulmonary tuberculosis; Africa