Survival analysis of time to cure on multi-drug resistance tuberculosis patients in Amhara region, Ethiopia

Abstract

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is caused by bacteria that are resistant to the most effective anti-tuberculosis drug. The MDR-TB is an increasing global problem and the spread of MDR-TB has different recovery time for different patients. Therefore, this study aimed to investigate the recovery time of MDR-TB patients in Amhara region, Ethiopia.MethodA retrospective study was carried out in seven hospitals having MDR-TB treatment center of Amhara region, Ethiopia from September 2015 to February 2018. An accelerated failure time and parametric shared frailty models were employed.ResultsThe study revealed that the recovery time of MDR-TB patients in Amhara region was 21 months. Out of the total MDR-TB patients, 110 (35.4%) censored and 201 (64.6%) cured of MDR-TB. The clustering effect of frailty model was hospitals and the Weibull-gamma shared frailty model was selected among all and hence used for this study. The study showed that extra pulmonary MDR-TB patients had longer recovery time than that of seamier pulmonary MDR-TB patients in Amhara region, Ethiopia. According to this study, male MDR-TB patients, MDR-TB patients with co-morbidity and clinical complication were experiencing longer recovery time than that of the counter groups. This study also showed that MDR-TB patients with poor adherence had longer recovery time than those with good adherence MDR-TB patients.ConclusionAmong different factors considered in this study, MDR-TB type, clinical complication, adherence, co-morbidities, sex, and smoking status had a significant effect on recovery time of MDR-TB patients in Amhara region, Ethiopia.In conclusion, the Regional and Federal Government of Ethiopia should take immediate steps to address causes of recovery time of MDR-TB patients in Amhara region through encouraging adherence, early case detection, and proper handling of drug-susceptibility according to WHO guidelines.

Predictors of mortality among multidrug-resistant tuberculosis patients in central Ethiopia: a retrospective follow-up study

“…resulting in reduced oxygen exchange and respiratory insufficiency. MDR-TB patients with clinical complications also experience longer recovery times and poor response to TB-medications [31,35]. The relationship between a low BMI and risk of death has been noted in several studies worldwide [24,28,34,[36][37][38] and has been strongly linked to poor nutritional status, which was evident in over 70% of our patient cohort.…”

“…Patients with acute lung complications had a higher risk of death as a consequence of infection of the lower respiratory tract leading to the accumulation of inflammatory exudate in the alveoli resulting in reduced oxygen exchange and respiratory insufficiency. MDR-TB patients with clinical complications also experience longer recovery times and poor response to TB-medications [31, 35]. The relationship between a low BMI and risk of death has been noted in several studies worldwide [24, 28, 34, 36–38] and has been strongly linked to poor nutritional status, which was evident in over 70% of our patient cohort.…”

“…Furthermore, the majority were co-infected with HIV, had low BMI, increased co-morbidities and clinical complications all of which would accelerate their mortality [13, 22]. Medications given for co-morbid conditions may interact with MDR-TB drugs and overlap in toxicity, often leading to poor compliance by patients [13, 31]. For example, the management of MDR-TB is similar for both diabetic and non-diabetic patients and it is recognised that diabetes patients have worse TB treatment outcomes due to the induction of poor glucose control by TB itself [32].…”

Poor treatment outcome and its predictors among drug-resistant tuberculosis patients in Ethiopia: A systematic review and meta-analysis

“…Then, 347 articles were screened by title and abstract. The full-text screening was conducted for 58 articles, and 17 articles that fulfilled the eligibility criteria were included in the final analysis (Ketema et al, 2019;Molie et al, 2019;Alene et al, 2017;Limenih and Workie, 2019;Woldeyohannes et al, 2019;Tola et al, 2019;Meressa et al, 2015;Getachew et al, 2013;Girum et al, 2017;Shimbre et al, 2020;Gebre et al, 2020;Fantaw et al, 2018;Molalign and Wencheko, 2015;Woya et al, 2019;Abebe et al, 2020;Baye et al, 2018;Tulu and Kahissay, 2014) (Table 1 and Figure 1). All of the studies were hospital-based retrospective cohort studies conducted among patients with DR-TB treated under TICs found in different parts of the country.…”

“…The poor treatment outcome is the share of different risk factors. Among the risk factors are being HIV positive, the weight of the patient, age of the patient, presence of other comorbidities or co-infections, smoking, alcohol, patient condition, delay to start treatment, resistance to more than two anti-TB drugs and involvement of TB outside the lungs are reported (Chung-Delgado et al, 2015;Ketema et al, 2019;Bajehson et al, 2019;Balabanova et al, 2016;Chingonzoh et al, 2018;Khan et al, 2015;Farley et al, 2011;Li et al, 2016;Makhmudova et al, 2019;Kurbatova et al, 2012;Bei et al, 2018;Alene et al, 2017;Limenih and Workie, 2019;Woldeyohannes et al, 2019).…”