Delayed sputum conversion and its association with nutritional intake and other factors among smear positive pulmonary tuberculosis patients in Kota Kinabalu, Sabah

Abstract

Tuberculosis (TB) control system aims to control disease spread, and the most effective way to prevent transmission is to cure patients with smear-positive pulmonary TB (PTB) that is highly contagious. Conversion of sputum smear is not only an indication of the patient’s response to therapy but also the measurement of efficiency of the TB treatment programme. This study aims to determine factors that contribute to the delayed conversion of sputum smear at the end of the intensive phase of TB therapy. This cross sectional study was carried out on patients with smear-positive PTB patients treated in the five TB treatment centre in Kota Kinabalu, Sabah, Malaysia, from June 2019 to February 2020. Logistic regression models were used to assess the association of socio demographic characteristics, clinical variables, nutritional status, and dietary intake with the delayed conversion of sputum smear. Thirty-five (13.9%) patients were identified as having delayed sputum conversion. Multiple logistic regression analysis found that PR1 Manggatal (aOR:10.202, 95% CI:3.309-31.457), no DOTS supervisor (aOR:17.20, 95% CI:3.020-98.054), advanced chest x-ray finding (aOR:7.463, 95% CI: 1.308-42.587), high total white cell (TWC) (aOR:6.051, 95% CI:1.987-18.422), high urea (aOR: 7.737, 95% CI: 2.055-29.120), anaemia (aOR: 6.263, 95% CI:1.671-23.476) low vitamin A intake (aOR:1.006, 95% CI:1.002-1.012) and low vit C intake (aOR:1.032, 95% CI:1.002-1.062) were associated with delayed sputum conversion. In conclusion, the sputum conversion rate among TB patients in this study was satisfying. The delayed sputum conversion was associated with PR1 Manggatal treatment centre, no DOTS supervisor, advanced chest x-ray finding, high TWC, high urea, anaemia, and low vitamin A and low vitamin C intake. To improve the sputum smear conversion rate, we need to increase the number of DOTS supervisor and early detection of PTB to prevent advanced PTB during diagnosis. Future studies should evaluate the mechanisms in which high urea is associated with delayed sputum conversion. Nonetheless, TB patients of rural residence warrant special attention. Nutritional referral and support for those who are needed may be beneficial.