Sputum smear-positive, culture-negative state during anti-tuberculosis treatment in the MGIT liquid culture era.

The sputum smear-positive, culture-negative state poses a challenge for clinicians. Previous studies have shown that most samples with positive smears during the later stages of treatment are culture-negative. Earlier studies generally used solid culture media, which tend to be less sensitive than current liquid culture systems. We examined the smear-positive, culture-negative state in the era of MGIT™ 960™ liquid cultures. We found that the smear-positive, culture-negative state occurred less frequently with MGIT culture, and that the majority of the samples with late positive smears were culture-negative, regardless of media type.

Comparison of time to positive and colony counting in an early bactericidal activity study of anti-tuberculosis treatment.

SETTING: Patients with smear-positive, newly diagnosed pulmonary tuberculosis (TB) presenting to the out-patient TB clinic in Kampala, Uganda. OBJECTIVE: To compare colony-forming unit (cfu) counting and time to positive (TTP) in Mycobacteria Growth Indicator Tube (MGIT) culture as measures of early bactericidal activity (EBA). DESIGN: Patients were enrolled in an EBA feasibility study of standard TB chemotherapy. Sixteen-hour overnight sputum collections were obtained before and on days 2, 4, 7, 10, 12 and 14 of treatment for quantitative culture on selective Middlebrook 7H11 agar media and TTP in the MGIT liquid culture system. RESULTS: Log cfu and TTP were correlated over all time points (r(s) = -0.71, P < 0.001). Within-subject (day to day) variation as a percentage of total variation was very similar between the two measures: 25.7% for cfu and 25% for TTP. Mean EBA 0-14, 0-2 and 2-14 measured by TTP were similar to those previously reported. CONCLUSION: TTP measured by an automated, standardized, commercially available culture system correlates with cfu determinations. EBA measured by TTP provides similar information to cfu counting, and is reproducible across sites and in different patient populations. These findings support replacing cfu counting with TTP as the primary measurement in EBA studies.

Assessment of Partogram use during Labour in Rujumbura Health Sub District; Rukungiri District; Uganda

Background: A partogram is a universal tool for monitoring labour. It is used for labour management in Rujumbura HSD; Rukungiri District. However; the District Health Officer reported only 30use of a partogram. The study intended to find out why the low use; and suggest strategies in scaling up. Objectives: To establish extent of use of a partogram; health facility and health workers' factors that affected its use during labour plus the relationship between foetal Apgar score and its use. Materials and Methods: A cross-sectional study involving observations; record reviews and interviewing of staff in 8 health facilities (4 Public and 4 Private Not For Profit) in Rujumbura HSD in Rukungiri district was conducted from May 23rd to 27th June 2008. It employed both qualitative and quantitative methods of data collection. Results: The partogram was used in 69.9of deliveries. The partographs that fulfilled the standard monitoring of foetal heart rate were only 2. There were few trained health workers and lack of guidelines on partogram use. A good Apgar score was associated with standard foetal monitoring and was statistically significant (P 0.001). Conclusions and recommendations: There was poor use of partograms during labour mainly affected by health input factors. We recommended training of health workers on partogram use; provision of guidelines and adequate resources