Tuberculosis in Kenya: follow-up of the second (1974) national sampling survey and a comparison with the follow-up data from the first (1964) national sampling survey. An East African and British Medical Research Council co-operative investigation.
A total of 1,490 newly diagnosed patients admitted to a national sampling survey of tuberculosis conducted in 11 of 30 districts in Kenya in 1974 have been followed up after a year under the routine tuberculosis treatment services. The results are reported and compared with those observed in the follow-up of a similar survey in the same districts 10 years previously. The main follow-up concerns 1,351 patients with pulmonary tuberculosis of whom 803 had a positive culture at the start of treatment, 283 a negative culture, and 265 had no specimen examined. At 1 year or later, 57% of the 1,351 patients were culture negative, 8% were culture positive, 16% had died in the year of follow-up, 5% were permanently lost from observation and 14%, although known to be alive, had no bacteriological results. Of the 803 patients with a positive culture initially, 11% had a positive culture at 1 year or later, as had 3% of the 283 with a negative culture initially. The policies of therapy practised in the routine treatment services were studied in 1,207 patients; 95% were admitted to hospital at the start of chemotherapy for an average duration of 39 days, 95% were prescribed isoniazid and thiacetazone supplemented initially by a course of streptomycin, the average duration of which was 36 days. There was little variation in the policies applied in different district. Only 24% of the patients received or attended to collect a 12 months' supply of chemotherapy and 72% a 6 months' supply. The therapeutic results achieved in 1974 compare favourably with those observed in the 1964 survey. The estimated culture negativity rate at 1 year or later for the patients who had bacteriologically confirmed disease initially was 63% in the earlier survey and 71% in the 1974 survey. The proportion of patients lost from observation was 9% in 1964 and 5% in 1974. The policies of therapy were much more standardised in the second survey. In 1964 hospital admission, its duration and the usage of streptomycin varied considerably from district to district, but in the second survey nearly all of the patients were admitted to hospital and received the nationally recommended regimen of isoniazid and thiacetazone supplemented initially by streptomycin. Even so, the duration of chemotherapy received did not improve, only 28% in 1964 and 24% in 1974 receiving a 12 months' and 74% in 1964 and 72% in 1974 receiving a 6 months' supply. The transfer of patients from one district to another was more often successful in 1974 than 1964.