Unfavorable Treatment Outcome and Its Predictors Among Patients with Multidrug-Resistance Tuberculosis in Southern Ethiopia in 2014 to 2019: A Multi-Center Retrospective Follow-Up Study

Bogale, Lemlem; Tsegaye, Tewodros; Abdulkadir, Mohamed; Akalu, Temesgen Yihunie

doi:10.2147/idr.s300814

Cited by 18 publications

(13 citation statements)

References 23 publications

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“…The current study found a 77.12% (95% CI = 73.0–81.5) MDR/RR-TB TSR, which is in agreement with the 75.7% national TSR report (from 2009 to 2019) by Habteyes Tola. 21 Other retrospective studies conducted in Addis Ababa (2011–2016) 26 and Southern-Ethiopia (2014–2019) 27 also reported similar findings, 76.9% and 76.32%, respectively. However, according to a review paper published in 2020, the overall pooled TSR in Ethiopia was 63.82%, which was less than the current report.…”

Section: Discussionsupporting

confidence: 52%

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Multidrug-Resistant Tuberculosis Treatment Outcome and Associated Factors at the University of Gondar Comprehensive Specialized Hospital: A Ten-Year Retrospective Study

Belachew¹,

Yaheya²,

Tilahun³

et al. 2022

IDR

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Background Multidrug-resistant tuberculosis (MDR-TB) remains a public health crisis and a health security threat worldwide. Poor public health infrastructure, inefficient infection control and mismanagement of TB treatment are among the reasons for the continuous emergence and spread of drug-resistant TB (DR-TB). The final treatment outcome is the most direct measurement of TB control programs. Therefore, this study sought to determine the proportions and predictors of TB treatment outcomes among MDR/RR-TB treated patients. Methods A 10-year, 2011 to 2021, hospital-based retrospective cohort study was conducted at the University of Gondar Comprehensive Specialized Hospital. The records of 408 MDR-TB patients, 389 with treatment outcome and 19 on treatment, were collected using a structured checklist. Results A total of 389 patients with a recorded MDR/RR-TB treatment outcome were included. The treatment success rate was 77.12%, with 58.35% cured and 18.76% treatment completed. The proportion of death rate, treatment default loss to follow-up, treatment failure, and unknown treatment outcome was 9.25%, 6.94%, 3.1%, and 3.6%, respectively. Regarding the patient category, the most successful treatment outcome (83.5%) came from patients diagnosed with relapse cases, followed by new cases (81.8%). An unsuccessful treatment outcome was significantly associated with patients aged >44 years (AOR, 3.3, 95% CI = 1.55–6.99). Conclusion and Recommendations This study indicated that nearly 23% of MDR/RR-TB patients had unsuccessful treatment outcomes and being older was significantly correlated with these outcomes. For better outcomes, it is recommended to strengthen combined treatment adherence interventions and evaluate treatment regimens and administration options. A prospective cohort study may be required to investigate the full range of potential causes of unfavorable outcomes.

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Section: Discussionsupporting

confidence: 52%

“…The mortality rate in the current study was 9.25% (95% CI = 6.2–12.3), which is in agreement with a report from Southern Ethiopia, 9.37%. 27 However, it was lower than other individual reports in Ethiopia. 22 , 28–31 The current result was even lower than death rates reported using nationwide data.…”

Section: Discussionmentioning

confidence: 68%

Multidrug-Resistant Tuberculosis Treatment Outcome and Associated Factors at the University of Gondar Comprehensive Specialized Hospital: A Ten-Year Retrospective Study

Belachew¹,

Yaheya²,

Tilahun³

et al. 2022

IDR

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“…The degree of sputum AFB positivity or grading was assigned to one of the five categories (negative, scanty, 1+, 2+, and 3+). The sputum bacillary load was graded as negative when there were no tuberculosis bacilli per 100 field of observation, as scanty when there was one to nine bacilli per 100 field of observation, as plus one (1+) when there was 10–99 bacilli per 100 fields of observations, plus two (2+) when the observed bacilli were 1–10 per field, and three plus (3+) when the number of bacilli was greater than 10 per field of observation ( 17 , 18 ).…”

Section: Methodsmentioning

confidence: 99%

“…The isolation of MTB in sputum cultures was performed in Löwenstein–Jensen (LJ) solid medium and recorded as follows; no growth (none), record actual number (1–9 colonies), 1+ (10–100 colonies), 2+ (> 100–200 colonies), 3+ (> 200 colonies), positive for other mycobacteria (other mycobacterial growth), contaminated (contaminated), and positive for MTB and contamination ( 17 , 18 ).…”

Section: Methodsmentioning

confidence: 99%

Sputum smear conversion and treatment outcomes among drug-resistant pulmonary tuberculosis patients in eastern Ethiopia: A 9-years data analysis

et al. 2022

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BackgroundDrug-resistant tuberculosis (DR-TB) has become a public health problem throughout the world and about one-third of deaths were attributed to DR-TB from antimicrobial resistance which contributes to 10% of all TB deaths. Sub-Saharan Africa, particularly Ethiopia accounts for a significant number of TB cases. However, the scanty evidence on DR-TB contributing factors could affect the level of this deadly case tackling program. Therefore, this study aimed to assess the factors affecting sputum smear conversion and treatment outcomes among patients with DR-TB in Health facilities in Eastern Ethiopia.Methods and materialsA cross-sectional study design was employed from 10 October to 10 November 2021, in the health facilities providing DR-TB services in Harari Region and Dire Dawa city administration. The medical records of 273 DR-TB patients from 10 January 2013 to 27 December 2021, were reviewed using structured checklists. Data were entered into Epidata 3.1 version and exported to STATA 14 version for analysis. The outcome variables were Initial Sputum conversion (converted vs. not-converted) and treatment outcome (Unfavorable vs. Favorable). Sputum examination was performed using both Acid-fast bacillus (AFB) smear microscopy and Löwenstein–Jensen (LJ) culture technique. A binary logistic regression analysis was used to assess the association of independent variables with the first month sputum smear conversion, while a conditional logistic regression model was used to assess the association of treatment outcome with explanatory variables. The associations were reported using adjusted odds ratios (AORs) at a 95% confidence interval.ResultsA total of 273 DR-TB patients were included in this study. The unfavorable DR-TB treatment outcome was significantly associated with the history of chewing khat (AOR = 4.38, 95% CI = 1.62, 11.84), having bilateral lung cavity on baseline chest X-ray (AOR = 12.08, 95% CI = 1.80, 2.57), having greater than 2+ smear result at baseline (AOR = 3.79, 95% CI = 1.35, 10.59), and poor adherence (AOR = 2.9, 95% CI = 1.28, 6.82). The sputum smear non-conversion at first month was significantly associated with being Human Immune Virus (HIV)-negative (AOR = 0.37, 0.17, 0.82), having low baseline BMI (AOR = 0.54, 95% CI = 0.29, 0.97), baseline culture > 2++ (AOR = 0.15, 95% CI = 0.05, 0.49) and having greater than 2+ sputum smear result (AOR = 0.09, 95% CI = 0.012, 0.67). Patients with normal chest X-ray at baseline had 3.8 times higher chance of sputum smear conversion on first month (AOR = 3.77, 1.11, 12.77).ConclusionThe overall initial sputum smear conversion and the treatment success rate among DR-TB patients were 52.75 and 66.30%, respectively. The Baseline underweight, HIV-negative, baseline smear > 2+, baseline culture > 2++, and clear lung on baseline X-ray were associated with smear conversion and history of khat chewing, bilateral lung cavity at baseline, having greater than 2+ smear results at baseline, and patients with poor treatment adherence had hostile treatment outcomes. So, strengthening and implementing nutrition assessment and patient counseling during directly observed therapies (DOTs) service and drug compliance could result in early sputum conversion and better treatment outcomes. DR-TB patients with high bacterial load and abnormal lungs on radiologic examination at baseline could need special attention during their course of treatment.

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“…Factors such as hospitalizations for care, male sex, and low hemoglobin level increased the risk of unfavorable treatment outcomes. 6 In a national TB service quality assessment across Ethiopia, the treatment success rate for DR-TB patients was 70%. Three percent of the patients failed DR-TB treatment and were moved to pre-XDR drug-resistant TB treatment; 10% died during treatment; and 11% were loss-to-follow-up (LTFU).…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcome of MDR/RR TB in a Resource-Constrained Setup: A Four-Year Retrospective Analysis

Omer¹,

Meshesha²,

Ajema³

et al. 2022

IDR

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The emergence of drug resistance in TB treatment is a major public health threat. However, there are limited studies which are directed towards identifying factors that explain the gap in achieving treatment targets.Objective: : This study aimed to assess the treatment outcome and its associated factors among patients with MDR/RR-TB in Dilchora Hospital Treatment Initiation Center from January 2014 to December 2018. Method: : A retrospective cross-sectional study was conducted on patients with MDR/RR TB who initiated treatment between January 2014 and December 2018. Data were extracted from patient medical charts using a structured questionnaire. SPSS version 26 was used for analysis. Reports are presented using percentages and frequency. Independently associated factors for unfavorable outcome were identified using binary logistic regression model. Adjusted and crude odds ratio with 95% CI was used. P-value less than 0.05 was used to declare statistical significance. Result: : A total of 146 patients were included in this study. The overall prevalence of unfavorable outcomes in this study for those with known outcomes was 8.6%. People living with HIV had a 6.47 times (95% CI: 1.14-36.68) increased odds of death as compared to those who are HIV negative. For every 1kg/m 2 increment in BMI, there was a 35.3% (AOR = 0.647; CI: 0.44-0.95) reduction in the odds of death as compared to those who had a 1kg/m2 lower BMI. Each additional month without culture conversion also increased the odds of death 2.24 times (95%CI: 1.08-4.66). Conclusion & Recommendation:: The findings of our study showed an appreciably low poor treatment outcome for this outpatient program. HIV screening and early initiation of HAART, early identification and treatment of those who are underweight and a critical follow-up to the time of sputum culture conversion could help in further improving the outcomes.

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Unfavorable Treatment Outcome and Its Predictors Among Patients with Multidrug-Resistance Tuberculosis in Southern Ethiopia in 2014 to 2019: A Multi-Center Retrospective Follow-Up Study

Cited by 18 publications

References 23 publications

Multidrug-Resistant Tuberculosis Treatment Outcome and Associated Factors at the University of Gondar Comprehensive Specialized Hospital: A Ten-Year Retrospective Study

Multidrug-Resistant Tuberculosis Treatment Outcome and Associated Factors at the University of Gondar Comprehensive Specialized Hospital: A Ten-Year Retrospective Study

Sputum smear conversion and treatment outcomes among drug-resistant pulmonary tuberculosis patients in eastern Ethiopia: A 9-years data analysis

Treatment Outcome of MDR/RR TB in a Resource-Constrained Setup: A Four-Year Retrospective Analysis

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