Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study.
Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study.
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DOI：
10.1186/s12890-021-01483-w
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发表时间：
2021-04-08
影响因子：
3.1
通讯作者：
Asemahagn MA
中科院分区：
文献类型：
--
作者：
Asemahagn MA
痰涂片转化是细菌学确诊的肺结核（PTB）患者治疗反应和传染性降低的关键指标。本研究旨在估计埃塞俄比亚西北部东 Gojjam 地区细菌学确诊的 PTB 病例中痰涂片转化情况并确定阻碍痰涂片转化的因素。通过每周痰涂片检查，对总共 282 名细菌学确诊的 PTB 患者进行了为期 22 周的随访。由于缺乏痰培养和快速诊断服务，使用抗酸杆菌染色技术对 5% 次氯酸钠浓缩技术的沉积物进行显微镜下痰涂片转化评估。使用预先测试的访谈者填写的问卷收集有关社会人口统计、临床概况和个人行为变量的数据。计算各种描述性统计数据，包括平均值、四分位距中位数 (IQR) 和比例，以描述研究目标。通过多变量逻辑回归分析确定痰涂片转化的因素，并在 p 值 < 0.05 时确定统计显着性。 超过一半的经细菌学确诊的肺结核患者为男性，其中 166 名（59%）为男性，147 名（52%）为农村居民。受访者的平均年龄为 35±5 SD 岁。约 88 名（31.2%）经细菌学确诊的 PTB 患者有合并症，102 名（36.2%）名面临耻辱，54 名（19%）有吸烟史。强化阶段和治疗随访第 5 个月的痰涂片转化中位数分别为 35 天（IQR：21-56 天）和 53 天（IQR：28-82 天）。 大多数细菌学确诊的 PTB 患者在治疗第 2 个月和第 5 个月结束时分别有 85%（95% CI 76-93%）和 95%（95% CI 85-99%）接受了痰涂片转化。对结核病的了解不足、艾滋病毒呈阳性、涂片分级较高、患有糖尿病、营养不良、吸烟、面临社会耻辱以及结核病服务延误与痰涂片转化的时间呈正相关（p值 < 0.05）。根据这项研究，与结核病计划的预期和之前研究的结果相比，痰涂片转换时间中位数要更高。该研究还确定了与痰涂片转换时间相关的重要因素。通过修改现有的社区意识策略来提高社区的健康素养对于提高治疗依从性和降低治疗开始后的传染性至关重要。 在线版本包含可在 10.1186/s12890-021-01483-w 获取的补充材料。
Sputum smear conversion is a key indicator of treatment response and reduced infectivity among bacteriologically confirmed pulmonary tuberculosis (PTB) patients. This study aimed at estimating sputum smear conversion and identifying factors hindering sputum smear conversion among bacteriologically confirmed PTB cases in East Gojjam Zone, Northwest Ethiopia. A total of 282 bacteriologically confirmed PTB patients were followed for 22 weeks through weekly sputum smear examination. Due to the absence of sputum culture and rapid diagnostic services, sputum smear conversion evaluation was conducted microscopically using acid-fast-bacilli staining technique of sediments from a 5% sodium hypochlorite concentration technique. Data on socio-demographic, clinical profile and personal behavior variables were collected using a pretested interviewer-administered questionnaire. Various descriptive statistics including mean, median with interquartile range (IQR), and proportions were computed to describe study objectives. Factors of sputum smear conversion were identified by multivariable logistic regression analysis and statistical significance was determined at a p value < 0.05. Over half, 166 (59%) of bacteriologically confirmed PTB patients were males and 147 (52%) were rural dwellers. The mean age of respondents was 35 ± 5 SD years. About 88 (31.2%) of bacteriologically confirmed PTB patients had comorbidities, 102 (36.2%) faced stigma, and 54 (19%) history of cigarette smoking. The median sputum smear conversions during the intensive phase and 5th months of treatment follow up were 35 dyas (IQR: 21-56 days) and 53 days (IQR: 28-82 days), respectuvely. The majority, 85% (95% CI 76–93%) and 95% (95% CI 85–99%) of bacteriologically confirmed PTB patients underwent sputum smear conversion at the end of 2nd and 5th months of treatment, respectively. Poor knowledge on TB, being HIV positive, higher smear grading, having diabetes mellitus, undernutrition, cigarette smoking, facing societal stigma, and TB service delays were positively associated with the length of sputum smear conversion (p value < 0.05). Based on this study, the median sputum smear conversion time was higher compared to TB program expectations and findings from former studies. The study also identified important factors associated with sputum smear conversion time. Improving health literacy of the community by revising the existing community awareness strategies is essential to enhance treatment adherence and lower infectiousness after treatment initiation. The online version contains supplementary material available at 10.1186/s12890-021-01483-w.
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