Treatment outcome of patients with smear-negative and smear-positive pulmonary tuberculosis in the National Tuberculosis Control Programme, Malawi

National tuberculosis control programmes (NTPs) in sub-Saharan Africa do no t routinely record or report treatment outcome data on smear-negative pulmo nary tuberculosis (PTB) patients. Twelve-month treatment outcome on patient s with smear-negative PTB registered in all district and mission hospitals in Malawi during the year 1995 was collected, and was compared with 8-month treatment outcome in smear-positive PTB patients registered during the sam e period. Of 4240 patients with smear-negative PTB, 35% completed treatment , 25% died, 9% defaulted and 7% were transferred to another district with n o treatment outcome results available. In 24% of patients treatment cards w ere lost and treatment outcome was unknown. These results were significantl y inferior to those obtained in 4003 patients with smear-positive PTB in wh om 72% completed treatment, 20% died, 4% defaulted, 2% were transferred and 1% had positive smears at the end of treatment. These differences between patients with smear-negative and smear-positive PTB were similar when analy sed by sex and by most age-groups. Higher mortality rates in patients with smear-negative PTB are probably attributable to advanced HIV related immuno suppression, and higher default and treatment unknown rates probably reflec t the lack of attention paid by TB programme staff to this group of patient s. As a result of this country-wide study the Malawi NTP has started to rec ord routinely the treatment outcomes of smear-negative TB patients and has set treatment completion targets of 50% or higher for this group of patient s.