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

N Anyama, S Sseguya, A Okwera, W A El-Naggar, F Mpagi, E Owino

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 pulmonaryTB 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.

Keywords: Tuberculosis, pulmonary, re-treatment, prevalence