Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study

Sahile, Zekariyas; Tezera, Robel; Mariam, Damen Haile; Collins, Jeffrey M.; Ali, Jemal Haider

doi:10.1371/journal.pone.0247945

Cited by 27 publications

(27 citation statements)

References 23 publications

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“…It was against our expectation that nutritional support could improve weight gain, adherence, and lead to a fast recovery. This expectation was also evidenced in previous reports [ 34 – 37 ] and that baseline body weight was a significant predictor of LTFU [ 38 , 39 ]. Other reports, however, pointed out that despite nutritional support contributing to improving patient nutritional status on the course of treatment, there was no sufficient evidence whether or not nutritional support is associated with a better TB treatment outcome [ 35 ].…”

Section: Discussionsupporting

confidence: 85%

Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study

Watumo¹,

Mengesha

Gobena

et al. 2022

BMC Public Health

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Background Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a major public health problem as patients can be infectious and also may develop a multi-drug resistant TB (MDR-TB). The study aimed to assess whether LTFU differs by the distance TB patients travelled to receive care from the nearest health facility. Methods A total of 402 patient cards of TB patients who received care were reviewed from March 1–30, 2020. The Kaplan-Meir curve with the Log-rank test was used to compare differences in LTFU by the distance travelled to reach to the nearest health facility for TB care. The Cox proportional hazard regression model was used to identify predictors. All statistical tests are declared significant at a p-value< 0.05. Results A total of 37 patients were LTFU with the incidence rate of 11.26 per 1000 person-months of observations (PMOs) (95% CI: 8.15–15.53). The incidence rate ratio was 12.19 (95% CI: 5.01–35.73) among the groups compared (those who travelled 10 km or more versus those who travelled less than 10 km). Age ≥ 45 years (aHR = 7.71, 95% CI: 1.72, 34.50), educational status (primary schooling, aHR = 3.54, 95% CI: 1.49, 8.40; secondary schooling, aHR = 2.75, 95% CI: 1.08, 7.03), lack of family support (aHR = 2.80, 95% CI: 1.27, 6.19), nutritional support (aHR = 3.40, 95% CI:1.68, 6.89), ≥ 10 km distance to travel to a health facility (aHR = 6.06, 95% CI: 2.33, 15.81) had significantly predicted LTFU from TB treatment and care. Conclusions LTFU from adult TB care and treatment was 12 times higher among those who travelled ≥10 km to reach a health facility compared to those who travelled less. To retain adult TB patients in care and ensure appropriate treatment, health professionals and other stakeholders should give due attention to the factors that drive LTFU. We suggest identifying concerns of older patients at admission and those who travel long distance and establish social support platforms that could help people to complete TB treatment.

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Section: Discussionsupporting

confidence: 85%

Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study

Watumo¹,

Mengesha

Gobena

et al. 2022

BMC Public Health

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“…We also found that the 41-50 year age group, ETC, and DPC contributed to female MDR-TB only. Although the underlying mechanisms are unclear, a possible explanation for these results may be the lack of adequate nutrition due to reducing body weight in females with PTBH (37). Women might have a low body mass index (BMI) because of poor nutrition and therefore develop MDR-TB.…”

Section: Predictors Of Incident Mdr-tbmentioning

confidence: 99%

Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study

Cheng

Xie

Wang

et al. 2021

Front. Public Health

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Background: To date, too little attention has been paid to monitoring and estimating the risk of incident multidrug-resistant tuberculosis (MDR-TB) among individuals with a previous tuberculosis history (PTBH). The purpose of this study was to assess the incidence of and risk factors for MDR-TB in those individuals.Methods: Between 2005 and 2020, a large, retrospective, population-based cohort study was performed in Hangzhou, China. A multivariable Cox regression model was used to evaluate independent predictors of incident MDR-TB among individuals with PTBH.Results: The incidence density of MDR-TB was 22.6 per 1,000 person-years (95% confidence level and an interval of 20.9–24.3) for individuals with PTBH. The incidence of MDR-TB increased significantly in individuals who• were under 60 years old.• were male.• had a history of direct contact.• came from low-income families.• worked in high-risk occupations.• lived in rural areas.• had a retreatment TB history.• had an unfavorable outcome in their previous treatment (P < 0.05).In addition, we found that the following factors were significantly linked to the MDR-TB risk among individuals with PTBH (P < 0.05):• sociodemographic factors such as the 21–30 and 31–40 year age groups, or a history of direct contact.• clinical factors like passive modes of TB case finding (PMTCF), human immunodeficiency virus infection, unfavorable treatment outcomes, retreated TB history, non-standardized treatment regimens of retreatment TB patients, and duration of pulmonary cavities (DPC).• microbiological factors, such as duration of positive sputum culture.We also found that the 21–30 year age group, low family income, and PMTCF were significantly linked to incident MDR-TB only in males with PTBH, whilst the 41–50 year age group, extended treatment course, and DPC were significantly associated with female MDR-TB only.Conclusion: The incidence of MDR-TB was high, with a higher rate among subjects with a history of direct contact and unfavorable treatment outcomes. There was a gender difference in the incidence density and risk factors of MDR-TB among individuals with PTBH. Long-term monitoring and gender-specific risk-factor modifications should be given to individuals with PTBH.

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Section: Discussionmentioning

confidence: 99%

“…24 Patients with low BMI appeared to have a low level of pro-inflammatory cytokines and a high level of regulatory cytokine, the opposite condition was found in patients with higher BMI, which conferred protective benefits of high BMI to TB disease progression. 25 However, high BMI was also associated with an increased risk of diabetes, which subsequently negates the beneficial effect of higher BMI to reduced the risk of TB infection and disease progression. 26,27 A limitation of our study was the small sample size, owing to the design of this study, which obtained the result of hematologic examination from medical records, meanwhile this examination was not routinely performed in Wangaya Hospital.…”

mentioning

confidence: 99%

High Pretreatment Level of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio and Other Factors Associated with Delayed Sputum Conversion in Patients with Pulmonary Tuberculosis

Suryana¹,

Dharmesti²,

Ngurah³

2022

IDR

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Introduction Patients with delayed intensive phase sputum conversion have a higher risk of multidrug resistant-tuberculosis (MDR-TB) and poorer treatment outcomes. Both, host (immune response and comorbidity) and pathogen factors play important roles in determining sputum conversion after treatment initiation. Impaired host immune response, especially the cellular components, as defined by the increased pre-treatment level of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR) and other additional factors, were associated with severe active TB. Purpose To evaluate whether impaired immune responses (high pre-treatment level of NLR and MLR) and other factors associate with delayed sputum conversion at the end of the intensive phase treatment. Patients and Methods This was a case–control study from 2016 to 2020, which retrospectively analyzed the pre-treatment level of NLR, MLR and other factors among patients with new cases of pulmonary tuberculosis (PTB). Results A total of 62 patients (31 cases and 31 control). The cut-off value of high pretreatment level of NLR and MLR was 5.065 and 0.585, respectively. Bivariate analysis showed that pretreatment NLR ≥5.065 (OR 8.23, CI 95% 2.48–27.32, p < 0.001), MLR ≥0.585 (OR 10.18, 95% CI 3.13–33.18, p < 0.001) and BMI <18.5 (OR 2.91, 95% CI 1.03–8.20, p = 0.041) were associated with an increased risk of delayed sputum conversion. Multivariate analysis, however, showed that pretreatment NLR ≥5.065 was not significantly associated with delayed sputum conversion (AOR 3.370, 95% CI 0.71–15.91, p value 0.125). A high pretreatment of MLR (AOR 30.802, 95% CI 3.22–287.55, p value 0.003) and lower BMI (AOR 10.942, 95% CI 1.121–98.563, p value 0.033) were significantly associated with an increased risk of delayed intensive phase sputum conversion. Conclusion High MLR pretreatment and a low BMI were significantly associated with an increased risk of delayed sputum conversion at the end of the PTB intensive phase treatment. High NLR pretreatment, smoking, diabetes, and HIV were not associated with sputum conversion.

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Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study

Cited by 27 publications

References 23 publications

Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study

Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study

Incidence Density and Predictors of Multidrug-Resistant Tuberculosis Among Individuals With Previous Tuberculosis History: A 15-Year Retrospective Cohort Study

High Pretreatment Level of Neutrophil to Lymphocyte Ratio, Monocyte to Lymphocyte Ratio and Other Factors Associated with Delayed Sputum Conversion in Patients with Pulmonary Tuberculosis

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