Time to Sputum Smear Conversion in Patients with Bacteriologically Confirmed Pulmonary Tuberculosis in Kiambu County, Kenya DOI: https://dx.doi.org/10.4314/ajhs.v38i1.4

Abstract

Introduction: Tuberculosis (TB) remains a significant global health burden, with 8.3 million new cases and 1.25 million deaths reported in 2023. Africa accounted for 24% of these cases, with Kenya ranking among the top 30 high-burden countries, reporting 97,126 TB cases. Kiambu County is among Kenya's top 12 high-burden counties, with a case notification rate of 189 per 100,000. Consequently, this study aimed to assess the time to sputum smear conversion and identify demographic, clinical, and socio-economic factors associated with delayed conversion among TB patients in Kiambu County.

Methods: A prospective longitudinal study was conducted among 316 newly diagnosed TB patients, who were followed from treatment initiation with weekly sputum smear assessments and monthly measurements of blood sugar and weight until smear conversion. Data were analysed using R Version 4.3.4 employing descriptive statistics, Cox Proportional Hazards Models, and survival analysis.

Results: Delayed sputum conversion was significantly associated with a high initial bacillary load (hazard ratio, HR = 1.52, p < 0.001), diabetes (HR = 1.20, p = 0.036), and poor socioeconomic status (HR = 1.16, p = 0.007). Conversely, older age groups 35–44 years (HR = 0.61, p = 0.037) and 55+ years (HR = 0.73, p = 0.032) demonstrated faster conversion rates.

Conclusion: This study underscores the importance of addressing demographic, socioeconomic, and clinical factors, such as area of residence, employment status, baseline bacillary load, diagnosis delays, and diabetes, to optimise sputum smear conversion. The findings highlight the need for targeted interventions and tailored strategies to enhance treatment success across diverse populations.