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Kosgei RJ, Sitienei JK, Kipruto H, Kimenye K, Gathara D, Odawa FX, Gichangi P, Callens S, Temmerman M, Sitienei JC, Kihara AB, Carter EJ. Gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis in Kenya. Int J Tuberc Lung Dis 2016; 19:1176-81. [PMID: 26459529 DOI: 10.5588/ijtld.15.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine gender differences in treatment outcomes among 15-49 year olds with smear-positive pulmonary tuberculosis (PTB) and factors associated with poor outcomes in Kenya. DESIGN Retrospective descriptive cohort. RESULTS Of 16 056 subjects analysed, 38% were female and 62% male. Females had a higher risk of poor treatment outcome than males (12% vs. 10%, P < 0.001; adjusted OR 1.29, 95%CI 1.16-1.44, P < 0.001). In the first multivariate model, restricting the analysis to human immunodeficiency virus (HIV) positive patients and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor outcome (OR 0.99, 95%CI 0.86-1.13, P = 0.844). In the model restricted to HIV-negative patients, a non-significantly lower risk was found (OR 0.89, 95%CI 0.73-1.09, P = 0.267). In the second model, restricting analysis to patients on antiretroviral therapy (ART) and adjusting for risk factors and clustering, females had a non-significantly lower risk of poor PTB treatment outcomes (OR 0.98, 95%CI 0.84-1.14, P = 0.792). In the model restricted to HIV-positive patients not on ART, a non-significantly higher risk was found (OR 1.15, 95%CI 0.79-1.67, P = 0.461). CONCLUSION Females of reproductive age are likely to have poorer treatment outcomes than males. Among females, not commencing ART during anti-tuberculosis treatment seemed to be associated with poor outcomes.
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Affiliation(s)
- R J Kosgei
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J K Sitienei
- Ministry of Health, Department of Disease Prevention and Control, Nairobi, Kenya; Moi University Department of Epidemiology, Nairobi Campus, Nairobi, Kenya
| | - H Kipruto
- World Health Organization, Nairobi, Kenya
| | - K Kimenye
- Division of Leprosy Tuberculosis and Lung Disease, Ministry of Health, Nairobi, Kenya
| | - D Gathara
- Ruby Medical Centre, Kiambu West, Kenya
| | - F X Odawa
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - P Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya, Kenya
| | - S Callens
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - M Temmerman
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J C Sitienei
- Department of Health Management, Moi University, Eldoret, Kenya
| | - A-B Kihara
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - E-J Carter
- Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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Kihara AB, Harries AD, Bissell K, Kizito W, Van Den Berg R, Mueke S, Mwangi A, Sitene JC, Gathara D, Kosgei RJ, Kiarie J, Gichangi P. Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007-2013. Public Health Action 2015; 5:23-9. [PMID: 26400598 DOI: 10.5588/pha.14.0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. OBJECTIVES Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. DESIGN Retrospective cross-sectional study using routine programme data. RESULTS During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. CONCLUSION This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.
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Affiliation(s)
- A-B Kihara
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Ruby Medical Centre, Kiambu West, Kenya
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - W Kizito
- Médecins Sans Frontières (MSF) Belgium, Nairobi, Kenya
| | - R Van Den Berg
- Medical Department, Brussels Operational Center, MSF-Luxembourg, Luxembourg
| | - S Mueke
- Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Ministry of Health, Nairobi, Kenya
| | - A Mwangi
- Moi University School of Medicine, Eldoret, Kenya
| | - J C Sitene
- Moi University School of Medicine, Eldoret, Kenya
| | - D Gathara
- Ruby Medical Centre, Kiambu West, Kenya
| | - R J Kosgei
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya
| | - J Kiarie
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya
| | - P Gichangi
- Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
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Kosgei RJ, Szkwarko D, Callens S, Gichangi P, Temmerman M, Kihara AB, Sitienei JJ, Cheserem EJ, Ndavi PM, Reid AJ, Carter EJ. Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya. Public Health Action 2015; 3:294-8. [PMID: 26393049 DOI: 10.5588/pha.13.0073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 09/27/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ≥2 weeks' duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya. DESIGN Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya. RESULTS Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26-35) and 26 years (IQR 24-31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at enrolment was 377 cells/μl (IQR 244-530) for HIV-infected women. One non-HIV-infected patient was sputum-positive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants. CONCLUSION This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a routine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.
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Affiliation(s)
- R J Kosgei
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - D Szkwarko
- AMPATH, Eldoret, Kenya ; The Memorial Hospital of Rhode Island Brown Family Medicine Residency Program, Pawtucket, Rhode Island, USA
| | - S Callens
- University of Ghent School of Medicine, Ghent, Belgium
| | - P Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - M Temmerman
- University of Ghent School of Medicine, Ghent, Belgium
| | - A-B Kihara
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - J J Sitienei
- AMPATH, Eldoret, Kenya ; Moi University School of Public Health, Eldoret, Kenya
| | - E J Cheserem
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - P M Ndavi
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - A J Reid
- Operational Research Unit, Médecins Sans Frontières Operational Centre Brussels, Luxembourg
| | - E J Carter
- AMPATH, Eldoret, Kenya ; Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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