Tuberculosis re-treatment outcomes within the public service in Nairobi, Kenya.

OBJECTIVES: This study was undertaken to describe treatment outcomes in patients started on a re-treatment drug regimen, assess the quality of follow up procedures and the adequacy of the currently advocated re-treatment drug regimen in Nairobi, Kenya. DESIGN: A retrospective study. SETTING: Mbagathi District Hospital (MDH), Nairobi, a public hospital that serves as the Tuberculosis (Tb) referral centre for Nairobi. MATERIALS AND METHODS: The Tb register at the MDH was used to identify patients who were on the re-treatment regimen for Tb. Case records for these patients were then retrieved. From these sources, information on age, sex, HIV status, previous and current tuberculosis disease and drug regimens, adherence to treatment and treatment outcomes, was obtained. Descriptive statistics was used to analyse the data. RESULTS: Of the total of 4702 patients registered at the MDH between 1996 and 1997, 593 (12.6%) were patients with either recurrent Tb, returning to treatment after default or had failed initial treatment. Of the 593 patients, case records were unavailable for 168 and 17 were children below the age of ten in whom the diagnosis of Tb was uncertain making a total of 185 patients who were excluded from the study. Of the remaining 408 patients, 77 (18.9%) were cured, 61 (15.0%) completed treatment without confirmation of cure, two (0.5%) defaulted, six (1.5%) died and 262 (64.2%) had no outcome information. There were no treatment failures. Treatment success defined as cure or treatment completion was achieved in 94.5% of the 146 patients in whom outcome data were available. HIV positive patients had a statistically significant poorer success rate (34/40, 85%) when compared with HIV negative patients (104/106, 94%), p=0.004. Mycobacterium tuberculosis culture and drug susceptibility testing, was not done. CONCLUSION: The high number of patients with no treatment outcome information at the MDH is worrying, as these patients may harbour drug resistant bacilli and reflects an inadequate follow up service for Tb re-treatment in Nairobi. However, where treatment outcomes could be assessed, the currently advocated re-treatment regimen achieved a high success rate. These observations point to an urgent need to improve Tb documentation and follow up procedures within the public service in Nairobi in order to forestall the emergence and spread of drug resistant Tb.

Upper gastrointestinal mucosal lesions in dyspeptic patients with homozygous sickle cell disease in Kenya.

A case controlled study comprising 51 patients with homozygous sickle cell (HbSS) disease who complained of dyspepsia and 41 age and sex matched non-HbSS control dyspeptic patients was carried out, to look at upper gastrointestinal mucosal lesions associated with dyspepsia. Upper gastrointestinal tract (UGIT) endoscopy was performed with gastric control biopsy taken for histology. Thirty two (62.3%) of the HbSS or sickle cell anaemia (SCA) patients had upper gastrointestinal pathology at endoscopy as compared to 17 (41.5%) of controls. The difference was significant at p = 0.042. Bile reflux (47%) was the predominant abnormal morphological finding in SCA patients while duodenal ulcer was the most common morphological finding in dyspeptic controls. The prevalence of duodenal ulcer in controls (22%) though higher than in SCA patients (9.8%), was not statistically significant p = 0.18. Gastric ulcer was not found in SCA patients. Duodenal ulcer was commoner in males than females in both cases and controls with a ratio of 4:1 and 3.5:1 respectively. Only four (7.8%) SCA patients and one (2.4%) of controls had normal mucosa at histology, the rest had evidence of histological gastritis. We could not draw any correlation between non-steroidal anti-inflammatory drugs (NSAIDS) use and UGIT findings. Since the proportion of SCA cases with UGIT abnormalities was significantly high, we recommend that dyspeptic SCA patients undergo UGIT investigations including endoscopy to maximise their clinical care.