The challenge of re-treatment pulmonary tuberculosis at two teaching and referral hospitals in Uganda.

Abstract

BACKGROUND: With an annual tuberculosis (TB) incidence of about 350 cases per 100,000 of the population, Uganda is a high burden country. Moreover, it is evident that some TB patients have been treated for a previous episode of the disease. OBJECTIVE: To highlight the burden of re-treatment pulmonary TB and examine patient factors associated with re-treatment among adults at two teaching and referral hospitals, Mbarara and Mulago. METHODS: A descriptive cross sectional study with data collection between September 2004 and March 2005; we calculated the prevalence and used logistic regression to explore factors associated with re-treatment. RESULTS: The prevalence of re-treatment pulmonary TB at Mbarara based on medical records was 30.0% (95%CI: 21.2 to 40.0), and 21.3% (95%CI: 12.9 to 31.8) from exit interviews. The corresponding estimates at Mulago hospital were 12.0% (95% CI: 6.4 to 20.0) and 43.9% (33.0 to 55.3). Compared to the 18-26 year age category, the prevalence odds ratio (POR) for a seven-year increase in age was 1.54 (95%CI: 1.04-2.28; p = 0.027), while female patients were 0.39 (95%CI: 0.17-0.90; p = 0.025) times less likely to report re-treatment disease than males, in this facility-based study. CONCLUSIONS: Re-treatment pulmonary TB is frequent at the two teaching and referral hospitals. A contribution to re-treatment prevention should entail more rigorous management of new TB cases, particularly at lower levels of care.