Tuberculosis Treatment Outcomes: A Fifteen Year Retrospective Study In Jos North And Mangu, Plateau State, North - Central Nigeria

Abstract

Background: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos North and Mangu Local Government Areas of Plateau State Nigeria. Methods: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State, North-Central Nigeria. Data were collected from 10156 TB patient’s health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariable and multivariable logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA.Results: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ±SD was 35.5±15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. After adjusting for sex, and TB category, being HIV positive was 2.8 times (95% CI: 1.11-6.83, p=0.028) more likely to be associated with treatment success than having an unknown status. Treatment after loss to follow-up, relapse and treatment failure were less likely associated with treatment success than newly diagnosed TB patients.Conclusion: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

Outcomes of tuberculosis treatment in a tertiary health facility in north-central Nigeria

“…However, the DOTS strategy is being challenged by many issues such as poor adherence, treatment default and failure (7,8). In this study, the finding of treatment success rate of 61.5% in the TB patients on treatment is similar to the report from another facility in north-central Nigeria which reported 67% of TB patients had successful treatment outcomes (10). Similar findings were also reported in other studies from East Africa with rates of successful treatment outcomes between 60% and 67% (12,13).…”

“…The low transfer out rate of 2.3% in our study may be a further testament to this. The high rate of death (7.8%) among TB patients in our study is similar to the report of a study from Jos, northcentral Nigeria (10), but lower than the death rates reported in studies from southern Nigeria by Bamidele et al, (11) and Umeokonkwo et al, (16). How-ever, the rate in our study is higher than those reported from other regions of Africa and Europe (12,17).…”

“…This study found that patients who defaulted their treatment or were lost to followup (25.8%) constituted majority of those with unsuccessful outcomes. This rate is slightly higher than the rates reported from some studies from Nigeria including one from the same region as ours where the default rate was 17%-18.5% (10,16). Similarly, studies elsewhere in Africa reported even lower rates of loss to follow-up (12,19).…”

“…Several studies have been conducted on treatment outcomes for TB in different states in Nigeria with different factors identified as contributing to the outcomes (10,11). This current study seeks to have a State and facility specific data to help in fashioning out facility specific interventions to improve TB treatment outcomes for patients accessing treatment in our facility.…”

Aspectos epidemiológicos da tuberculose e dos serviços de atendimento à pessoa com tuberculose no Município de Chimoio, Moçambique, 2018-2019

“…MOÇAMBIQUE, 2018.2.3.4 Fatores Associados ao Desfecho do Tratamento da TuberculoseEstudos têm mostrado que o alcance do tratamento bem-sucedido da TB depende em grande medida da combinação correta entre a condição clínica do paciente, regime terapêutico escolhido, cumprimento efetivo e a toma correta dos medicamentos durante o período definido. Portanto, nem sempre este desiderato é alcançado, pois não menos frequente regista-se desfechos desfavoráveis como a morte, falência terapêutica e abandono.Alguns fatores relacionados às características sociodemográficas, clínico-epidemiológicas dos doentes de TB e aos sistemas de saúde têm sidos identificados como de importância fundamental no processo do tratamento da doença(ANYANTI et al, 2020;DOS SANTOS et al, 2012 apud MS- Brasil, 2005.da doença e pela razão contrária estima-se que cerca de 64% de casos podem ter desfechos não favoráveis(SARIEM et al, 2020) como longos períodos de infecção, resistência aos medicamentos e a morte (TSEGAW e YIMER, 2018).Pela importância epidemiológica que a aderência ao tratamento representa no controle de doenças, esforços têm vindo a ser empreendidos no sentido de identificar as potenciais causas associadas à ocorrência contrária. Por exemplo, com base em um estudo randomizado envolvendo 234 novos casos de TB com aplicação de um questionário estruturado, T. S. BAM, et al(2006), identificaram que a provisão de informação diária sobre a importância de DOTS nos centros de atendimento de pacientes de TB influenciou significativamente para o sucesso (OR 6.27, 95%CI 2.88-13.64).Paralelamente, A. TRAJMAN et al, (2010) identificaram por meio de um estudo clínico randomizado que regimes curtos (4 meses) e baixas doses de medicamentos influenciaram para o sucesso na aderência ao tratamento nos primeiros meses de seguimento clínico.…”