ETD Collection

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    Analysis of secondary data from Mycobacterium vaccae tuberculosis clinical trial
    (2008-11-04T12:13:27Z) Mapingure, Munyaradzi Paul
    Background: Sputum culture conversion at two months is an important indicator for the effectiveness of treatment and the infectivity of a patient with pulmonary TB. This study aimed at investigating factors that are associated with tuberculosis culture conversion at two months as well as investigating whether sputum culture conversion at two months is a reliable predictor of relapse. Methods: The study makes use of data obtained from 347 newly diagnosed tuberculosis patients who participated in a randomized placebo controlled immunotherapy trial at King George V hospital in Durban. Above objectives were met by carrying out statistical analysis of the secondary data. Chi-square tests for categorical explanatory variables such as HIV status and smoking status and (b) t-tests for continuous variables such as age were used for investigating factors associated with 2-month culture conversion. Multivariate models were used to find the most important variables for predicting 2-month culture conversion. Kaplan Meier curves were used for investigating whether culture conversion at two months is a reliable predictor of relapse. Findings: Of the 347 tuberculosis patients, 34 % were HIV sero-positive. Age, body mass index (BMI), smoking status and gender were found to be important variables that affect sputum culture conversion at two months. At 5 % significance level there was no evidence that those who culture convert at two months were less likely to relapse than those who had not culture converted at two months (p=0.1165). However the trend shown is striking to report as it may be of clinical significance. Among those who had not culture converted at two months, more people (40) than expected (34) relapsed an among those who had culture converted at to months, less people (19) than expected (24) relapsed. Interpretation and recommendations: Some behavioral and biological factors affect two month tuberculosis culture conversion therefore successful tuberculosis management need to take into account the effect of these factors. This study did not show that the sterilizing potential of an anti-tuberculosis regimen can be obtained by evaluation of the culture conversion rates at two months and this may be due to small sample size.
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    Schizophrenia relapse in a community mental health setting
    (2008-03-12T12:24:43Z) Kazadi, Nyembue Jean-Bosco
    ABSTRACT AIM: The aim of this study was to determine, if any, the factors associated with relapse with a view to provide guidelines for prevention, early identification and management of relapse in a community setting. METHOD: The study is a retrospective record review of the patients attending seven randomly selected Community Mental Health Clinics in Southern Gauteng during the period January 1995 to June 2005. Two hundred and seventeen (217) patients aged 18 years with a diagnosis of schizophrenia were included in the study. Patients were excluded if the diagnosis of schizophrenia was made in the preceding six months of the study. Demographic and clinical variables including age, gender, marital status, source of income, highest level of education, non compliance, presence of substance abuse, co-morbid psychiatric condition, the presence and number of relapses and stressful life events were recorded on a data schedule. RESULTS: Two hundred and seventeen patients records were analysed: 61.8% have had at least one relapse. The only factors that provided a significant predictive factor for relapse included non compliance due side-effects, non compliance due to lack of insight, and the presence of depressive symptoms. 64.2% of the study population were non compliers and 27.1% have had depressive features. Demographic variables were not associated with relapse. CONCLUSION: These findings imply that interventions aimed at reducing relapse in schizophrenia should include improving medication compliance and early detection and treatment of depression.