Gopi, P G and Chandrasekaran, V and Subramani, R and Santha, T and Thomas, A and Selvakumar, N and Narayanan, P R
(2006)
Association of conversion & cure with initial smear grading
among new smear positive pulmonary tuberculosis patients
treated with Category I regimen.
Indian Journal of Medical Research, 123 (Jun).
pp. 807-814.
ISSN 0971-5916
Abstract
Background & objective: Early diagnosis of tuberculosis (TB) is important for initiating treatment
to gain cure. The present investigation was undertaken to study the association of conversion
and cure with initial smear grading among pulmonary tuberculosis (TB) patients registered in
a directly observed treatment – short course (DOTS) programme in Tiruvallur district, south
India.
Methods: All new smear positive cases registered from May, 1999 to December, 2002 were analysed
for conversion and cure related to initial smear grading.
Results: Of the 1463 patients, 1206(82.4%) were converted at the end of the intensive phase and
1109 (75.8%) were declared ‘cured’ after the completion of treatment. The cure rate decreased
as the initial smear grading increased and the decrease in trend was statistically significant
(P=0.01). Similarly, a significant decrease in conversion rate was also observed with increase in
initial smear grading (P<0.001). In multivariate analysis, lower cure rate was significantly
associated with patient’s age (AOR=1.5, 95% CI=1.1-2.1), alcoholism (AOR=1.7, 95% CI 1.2-
2.4) and conversion at the end of intensive phase (AOR=3.5, 95% CI= 2.6-4.8).
Interpretation & conclusion: Cure and conversion rates were linearly associated with initial
smear grading. High default and death rates were responsible for low cure and conversion. The
proportion of patients who required extension of treatment and those who had an unfavourable
treatment outcome were significantly higher among patients with a 3+ initial smear grading.
This reiterates the need to pay more attention in motivating these patients to return to regular
treatment and sustained commitment in the control of tuberculosis. There is a need to extend
the treatment for one more month in the intensive phase of treatment.
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