Adverse Treatment Outcomes among Tuberculosis Patients Enrolled Under Directly Observed Treatment Strategy in Murang'a County: A crossectional study.
DOI:
https://doi.org/10.47941/ijhs.1652Keywords:
Adverse treatment outcomes, tuberculosis patients, Murang'a CountyAbstract
Purpose: Despite advances in TB control, over 20% of TB patients in low and middle income countries end up with adverse treatment outcomes. We aimed to describe adverse treatment outcomes and explore the associated factors among TB patients enrolled in Murang'a county between 2017 and 2019.
Methodology: We conducted a crossectional study in which data was abstracted from patients records and analysed using Computer package (SPSS 24). Univariate and Multivariate analyses were done to describe relationships between individual or confounding independent variables and treatment outcomes. (p<0.05) and 95% CI. Incidence rate ratio and Odds ratio (OR) were calculated to asses effects of variables and strength of relationships.
Findings: Of 4414 participants, 87.4 % were aged ≤54 years, 57.8% were underweight and 21.5% were HIV positive. 7.5 % had adverse treatment outcomes with 85.3% dying, 9.6% failing and 5.1% converting to multi-drug resistance. Older age, underweight, being treated in Health centers and Hospitals, and negative mycobaterial test result were attributed to death, while older age, Male gender and negative or unknown mycobacterial test results predicted an adverse treatment outcome. Our study demonstrated importance of separate analyses for single and aggregated outcome, MDRTB as a treatment outcome and revealed un-known and negative myco-bacteriological test results as factors for death.
Unique contributor to theory, policy and practice: Special attention such as direct government funds transfer, treatment support, and close clinical care is reccommended for elderly patients to cater for inequities in their access to health care, and general welfare so as to prevent death and other adverse treatment outcomes among them. Behavior change programs should be prioritized for male patients to address substance abuse, poor health seeking behaviour and treatment adherence. Strict management, close monitoring and nutrition support is reccommended for patients treated in hosptals and health centers, and those at risk or already immune compromised such as the elderly, undernourished and those with co-morbidities . Strict case management and adherence counseling for patients with un-known sputum status as well as a further enquiry into the association between un-known sputum status and deaths is reccommended
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References
The Global Plan to End TB, 2018-2022. Geneva: Stop TB Partnership; 2019 (http:// stoptb.org/global/plan/plan 1822.asp,accessed 24 July 2021
Esmail H, Barry CE, Young DB, Wilkinson RJ. Philosophycal Transactions of the royal Society B: Biological Sciences. The ongoing challenge of latent uberculosis. 2014; 369(1645): 20130437. PubMed Google scholar
World Health Organization. Global tuberculosis report 2013. Geneva. 2013. Google scholar
Centers for Disease Control and Prevention. Plan to combat extensively drug -Resistant tuberculosis : recommendations of the Federal Tuberculosis Task Force. Centers for Disease Control and Prevention. 2009; 58 (3): 1-43. PubMed Google scholar
National Tuberculosis, Leprosy and Lung Disease Program. Annual report. 2021. MOH, Kenya.Accessed 26 January 2023
Fatiregun AA, Ojo AS, and Bamgboye A E. Treatment Outcomes among Plumonary Tuberculosis Patients at Treatment Center in Ibadan, Nigeria. Annals of Africa Medicine. 2009. 8, 100-104. http:// dx.doi.org/10.4103/1596-3519.56237
World Health Organization. Global tuberculosis report 2015. Geneva: 2015. Google scholar
Wobeser W., Yuan L., Naus M. (1999). Outcome of plumonary tuberculosis treatment in the tertiary care setting. The tuberculosis Treatment completion study Group.- Toronto 1992/93. CMAJ 1999;160: 789 -94.
WHO. Global Tuberculosis Report 2020. Geneva, Switzerland; 2020. Retrieved from: http://apps.www.who.int/publications/i/item/9789240013131 Accesed 10 June 2022
WHO. Global lists of high burden countries for TB, multidrug/rifampicin-resistant TB, (MDR/RR-TB) and TB/HIV, 2021-2025. Geneva: World Health Organization; 2021. eISBN 978-92-4-00978-92-4-002943-9
National Tuberculosis, Leprosy and Lung Disease Program. Annual report. 2019. MOH, Kenya.Accessed 12 November 2021
County Health Strategic and Investment Plan (CHSIP) 2020-2024; Murang'a County 2020.
Eshetie S, Gizachew M, Alebel A, Van Soolingen D. Tuberculosis treatment outcomes in Ethiopia from 2003 to 2016, and impact of HIV co-infection and prior drug exposure: A systematic review and meta-analysis. PLoS One. 2018;13 (3):e0194675. doi:10.1371/journal.pone 0194675 [PMC free article][PubMed][Cross ref] [Google scholar]
Gatie A, Alene B. Tuberculosis treatment outcomes and associated factors among patients treated at Woldia General Hospital in Northeast Ethiopia: an Institution - based Crossectional study. Infection and Drug Resistance. 2020;13:3423.doi:102147/IDR. S275568 [PMC free article][PubMed][Cross ref] [Google scholar]
I. Lucenko, V.Riekstina, J Perevoscikovs, D Mozgis, M Khogali, J. Gadoev, P. de Colombani, A.M.V Kumar. Treatment outcomes among drug-susceptible tuerculosis patients in Latvia, 2006-2010. Public Health Action. 2014 Oct 21;4 (Suppl 2):S54-S58. doi:105588/pha.14.0040 PMCID :PMC4547516│PMID:26393099
Akinola A. Fatiregun, Abimbola S. Ojo, Afolabi E. Bamgboye. (2009).Treatment outcomes among plumonary tuberculosis patients at treatment centers in Ibadan. Annals of African Medicine Vol. 8, No. 2;2009:100-104. DOI: 10.4103/1596-3519.56237
WHO. WHO Consolidated Guidelines on Tuberculosis: Module 4: Treatment -Drug -Susceptible Tuberculosis Treatment. World Health Organization. Geneva:2022. Available at: http:// www.who.int /publications /i/item/9789240048126 (Accessed on June 2022)
WHO. Implementing the WHO Stop TB Strategy: A Handbook for National Tuberculosis Control Programes. Geneva:World Health Organization; 2008. 2, Treatment of Tuberculosis patients. Available from: https:// www.ncbi.nlm.nih.gov /books /NBK310759/
Biruk M, Yimam B, Abrah H, Biruk S, Amdie FZ. Treatment outcomes of Tuberculosisand Associated Factors in an Ethiopian University Hospital. Adv Public Heal. 2016;2016:1-9. Available from: http://apps.www.hindawi.com/journals /aph/2016/8504629/.
Ayakaka I, Ackerman S, GgitaGgitaJ JM, Kajubi P, Dowdy D, Habert JE, et al. Identifying barriers to and facilitators of tuberculosis contact investigation in Kampala, Uganda : a behavioral approach. Implementation Sci 12, 23 (2017).https:// doi.org/10.1186/s13012-017-0561-4
Muluye A, Kebamo S, Teklie T, Alemkere G. Poor treatment outcomes and its determinants among tuberculosis patients in selected health facilities in East Wollega, Western Ethiopia. PLoS One. 2018;13(10):e0206227. doi:10.1371/journal.pone 0206227 [PMC free article][PubMed][Cross ref] [Google scholar]
Teferi M, Diana L, Hailu T, Woldensenbet S, Bekele S, Mirtskhulava A. Tuberculosis treatment Outcome and associated factors among tuberculosis patients at Wolaya Sodom Teaching and referal hospital, Southern Ethiopia: a retrospective study. Journal of Public Health Research. 2021.doi:104081/jphr.2021.2046 [PMC free article] [PubMed][Cross ref] [Google scholar]
Izudi J, Semakula D, Senono R, Tamwesigire I, Bajunirwe F. Treatment success rate among patients in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Open. 2019;9(9):e029400.Available from https://bmjopen.bmj.com/lookup/doi/10.11410.11436/ bmjopen -2019-029400.
WHO. Global Tuberculosis Report 2019. Geneva, Switzerland; Retrieved from: http://apps.www.who.int/publications/i/item/9789241565714
Molie T, Teklemariam Z, Klinkenberg E, Dessie Y,Kumsa A, Mohammed S.et al. Intensive phase treatment outcome and associated among patients treated for multi-drug resistant tuberculosis in Ethiopia :a retrospective cohort study. BMC Infect Dis. 2019;19;818 Scopus (7) [PubMed1][Cross ref] [Google scholar]
Nair D, Velayutha B, Kannan T, Tripathy J, Harris A, Natrajan M. et al. Predictors of unfavourable treatment outcome in patients with multi-drug resistant tuberculosis in India. Public Health Action. 2017;7:32-3 [PubMed][Cross ref] [Google scholar
Aasma L, Ali Iftikhar, C Asad A. (2015). Ecconomic Effects of Students' drop out. International journal of Economics, Commerce and Management. vol. III, issue 6, June 2015. UNited KIngdom http://ijecm.co.uk/
M Bhering, R. Duarte, A Kritski. Predictive factors for unfavourable treatment in MDR-TB and XDR -TB patients in Rio de Jeneiro State, Brazil, 2000- 2016 PLOS ONE, 14 (11)11 (2019), p.e0218299
Ketema D., Muchie K., And argentine A. Time to poor treatment outcome and it's predictors among drug-resistant tuberculosis patients on second-line Anti-tuberculosistreatment in Amara region, Ethiopia : A retrospective cohort study. BMC Public Health. 2019; 19: 1481 Scopus [PubMed][Cross ref] [Google scholar]
Madison D, Viola A. The Health of widows in the year following bereavement. Journal of psychosomatic research. 1968;12 : 279-306
Kosgei R, Callender S, Gichagini P, Temmerman M, Kiharu, David G. et al. Gender difference in mortality among Pulmonary tuberculosis HIV co-infection adults aged 15-49 years in Kenya. Kumar T, Editor. PLOS One. 2020; 15(12):e0243977. Available from: http:// doi.org/dx.plos.org/10.1371/journal.pone.
Mengesha M, Gebremichael M,Watt more D, Hallstrom I, Jerene D. Poor adult tuberculosis treatment outcomes and associated factors in Gibe Word, Southern Ethiopia: An Institution Based Crossectional study. PLOS Glob Public Health. 2022 Mar 10;2(3):e0000161. doi:10.1371/journal.pgph.0000161. PMID: 36962264; PMCID:PMC10021194.
AY. Adebe, W.Ayele, N. Furdu. Survival and it's Determinant of multidrug-resistant tuberculosis patients with HIV co-infection: St Peter Tuberculosis Specialized Hospital Adis Ababa, Ethiopia Adis Ababa University (2020) http:// /etd.aau.edu.et/handle/123456789/10156[Accessed 05 Jan 2020]
Ayinalem A, Zebenay WB, Testaverde W. Poor treatment outcomes and its predictors among drug-resistant tuberculosis patients in Ethiopia :A systematic review and meta-analysis. DOI: http:// doi.org/10.1016/j.ijid.2020.05.087 PMID32645375
Alene KA, Viney K, Gray DJ, McBride ES, Wagner M, Clement A. Mapping tuberculosis treatment outcomes in Ethiopia. BMC Infectious ddiseases 2019:19 (1)-11. doi:10.1186/s12879-018-3567-x [PMC free article][PubMed][Cross ref] [Google scholar]
C Jackson, HR Stagg, A Doshi, D Pan, A Sinha, S Batra, I Abubakar, M Lipman. Treatment outcomes among disadvataged patients in india, 2012 -2014. Public Health Action. 2017 Jun 21;7(2):134-140. Doi:10.5588/pha. 16.0107
Tola A, M inshore K, Ayele Y, Mekuria A. Tuberculosis treatment outcomes and associated factors among TB patients attending public hospitals in Harar town, Eastern Ethiopia: a five year retrospective study. Tuberculosis research and Treatment. 2019; doi:10.1155/2019/1503219 [PMC free article][PubMed][Cross ref] [Google scholar]
Achieng R Lorraine. Factors associated with tuberculosis treatment outcomes in TB-HIV co-infected and TB only patients in Nyando sub-county. URI:http://62.24.102.15:8080/xmlui/hanle/123456789/912 2016 JOOUST
Gavazi G, Hermann F, Krause K-H. Ageing and infectious disease in the developing world. Clin Infect Dis. 2004; 39:83-91. [Pub Med]
Heunis JC, Kigozi NG, Chikobvu P, Botha S, van Rensburg HCJD. Risk factors for mortality in TB patients :a 10-year electronic record review in a South African province. BMC Public Health. Biomedical Cemtral. 2017;17:38. PMC free article] [ PubMed ] [Google scholar]
Nkube RT, Takarinda KC, Zishiri C, Van den Boogaard W, Mlilo N, Chiteve C, Siziba N, Trichan F, Sandy C. Age-stratified tuberculosis treatment outcomes in Zimbabwe: Are we paying attention to the most vulnerable? Public Health Action. 2017 Sep21;7(3):212-217. doi:10.5588/pha.17.0024
Sowmya Bhat, Saurabh Kumar. Study on health seeking behaviour among elderly in rural area. International Journal of Medical Science and Public Health. http://www.ijmsph.com DOI: 10.5455/ijmsph.2017.26072016621
Piette JD, Heisler M, Waggner TH. Cost-related medication underuse among chronically ill adults. Am J Public Health. 2004;94(10): 1782-1787.
Heisler M, Wagner TH, Piette JD. Clinician identification of chronically ill patients who have problems paying for prescription medications. Am J Med.2004;116:(11):753-758.
Nikolaus T, Kruse W, Bach M. et al. Elderly patients' problems with medication an in-hospital and follow-up study. Eur J Clin Pharmacol.1996;49(4): 255-259) PubMed/Google scholar
Wilma Leslie, Catherine Hankey. (2015) Ageing, Nutritional status and Health. Health care (Basel). 2015 Sep;3(3):648-658. doi 10.3390/healthcare3030648 PMID 27417787
Elias M.Bukundi, Francis Mhimbira, Rogath Kishimba, Zuweina Kondo, Candida Moshiro. Mortality and associated factors among adult patients on tuberculosis treatment in Tanzania: A retrospective cohort study. J Clin Tuberc Other Mycobact Dis. 2021. July 18;24:100263. Doi 10.1016/j.jctube.2021.100263 PMCID:PMC8322306│PMID :34355068
Marian Khalif Ali, Simon Karanja, Muhammed Karama. Factors associated with tuberculosis treatment outcomes among tuberculosis patients attending tuberculosis treatment centers in 2016 - 2017 in Mogadishu, Somalia. The Pan African Medical Journal 2017;28: 197. doi 10.11604/panmj.2017.28.197.13439
Ali SA, Mavunda TR, Fantu R, Awoke T. Outcomes of TB treatment in HIV co- infected TB patients in Ethiopia:a crossectional analytic study. BMC infectious diseases. 2016;16(1):640 PubMed. Retrieved from ttps://www.ncbi.nlm.nih.gov>pubmed
Coimbra I. Maruza M, Albuquerque Mde F, Batisca JD, Braga MC, Meura LV. et al. Validating a scoring system for the diagnosis of smear -negative pulmonary tuberculosis in HIV -infected adults. State of Pernambuco, Brazil. PLoS One. 2014; 9(4) e95828.
Monk J, An D, KimS, Lee M, Kim C, Son H. Treatment outcomes and factors affecting treatment outcomes of new patients with tuberculosis in Busan,South Korea: a retrospective study of a citywide registry, 2014 -2015. BMC Infect Dis. Biomedical Central. 2018;18:1-9. [PMC free article][PubMed] [Google scholar]
Kudakwashe C, Takarinda, Charles Sandy, Nasha Masuka, Patrick Hazangwe, Regis C. Choto, Tsitsi Mutasa -Apollo, Brilliant Nkomo, Edwin Sibanda, Owen Mugurungi, Anthony D Harries, Nicholas Siziba. Factors associated with Mortality among Patients on TB Treatment in the Southern Region of Zimbabwe, 2013 ", Tuberculosis Research and Treatment, vol. 2017, Article ID 6232071, 11 pages, 2017. https:// doi.org / 10.1155/2017/6232071
Teklu AM, Nega A, Mamuye AT, Sitotaw Y, Kassa D, Mesfin G, Belayihun B, Medhin G, Yirdaw K. Factors associated with mortality of TB/HIV co-infected patients in Ethiopia. Ethiop J Health Sci. 2017 March 3;27 (1):29.https://doi.org/10.4314/ejhs.y27i14s.PubMed|Google Scholar
WHO. (2005) Global tuberculosis control: surveillance, planning, financing. WHO report 2005. Geneva, World Health Organization (WHO/HTM/TB/2005.349).
Francis Hamaimbo Nanzaluka, Sylvia Chibuye, Clara Chola Kasapo, Nella Langa, Nyambane Sinyange. Factors associated with Tuberculosis Mortality in Selected Health Facilities in Lusaka, Zambia. J Interval Epidemiological Public Health. 2021 July; 4 (3):10 doi:http:// doi.org / 10.37432/jieph.2021.4.3.39
Tweya H, Feldacker C, Phiri S, Ben-Smith A, Fenner L, John, A., et al. Comparison of treatment Outcomes of New Smear - Positive Pulmonary Tuberculosis Patients by HIV and Anti-retroviral Status in a TB/HIV Clinic, Malawi. PLOS One. 2013; 8,e56248. https://doi.org/10.1371/journal.pone.0056248
de Prado TN, Miranda AE, de Souza FM. et al. Factors associated with tuberculosis by HIV status in the Brazilian national surveillance system : a crossectional study. BMC Infect Dis. 2014; 14,415. https:// doi.org/10.1186/1471-2334-14-415
Luby SP, A M, Painter J, Billhimer WL, Hoekesra RM. Effect of intensive hand washing promotion on childhood diarrhea in high risk communities in Pakistan. JAMA. 2004; 291, 2547-2554
Frederick AD Kaona. An assessment of factors contributing to treatment adherence and knowledge of TB transmission among patients on TB treatment. Mumbai India. BMC Public Health. 2004; 4: 68. https://doi.org/10.1186/1471-2458-4-68
WHO. Report of a WHO Expert committee. Geneva: WHO;1995. Physical status: the use and interpretation of anthropometry.http://whqlibdoc.who.int/trs/WHO_TRS_854pdf
Yen YF, Chuang PH, Yen MY, Lin SY, Chuang P, Yuan MJ, Ho BL, Chou P, Chung-Deng CY. Association of Body Mass Index with Tuberculosis Mortality: A Population -Based Follow-up Study. Medicine (Baltimore). 2016 Jan: 95 (1):e2300 doi:10.1097/MD.0000000000002300 PMID:PMC4706252│PMID:26735532
Cegielski JP, McMurrayDN. The relationship between mulnutrition and tuberculosis: evidence from studies in humans and experimental animals . Int. J Tuberc Lung dis. 2004; 8:286-298 [PubMed]
Paton NI, Chua Y-K, Earnest A, Chee CBE. Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting. Am J Clin Nutr. 2004;80:460-465.
B Dhanaraj, MK Papana, S andinarayanan, V Sundaram. Prevalence and risk factors for adult pulmonary tuberculosis in a metropolitan city of South India. PLoS one. 2015- journals.plos.org PLos 10 (4), e0124260,2015
Schenk A, Macallan DC. Tuberculosis, malnuutrition and wasting. Curr Opin Clin Nutr Metab Care. 2000;3:285-95-91. [PubMed]
WHO. Guideline:Nutritional care and support for patients with tuberculosis. Geneva:WorldHealth Organization; 2013
Fabrice Nembot Djouma, Michel Noubom, Armelle Viviane Ngomba, Hubert Donfack, Patrick Stephane MMfin Koumboua, Michael Amede Fopa Saah. Determinants of death among tuberculosis patients in a semi urban diagnostic and treatment center of Bafoussam, West Cameroon: a retrospective case control study. Pan African Medical Journal. 22 (1),2015
Wait CJ, Squire SB. A systematic review of riskfactors for death in adult during and after tuberculosis treatment. Intl J Tuberc Lung Dis. 2011;15(7):871-885. PubMed/Google cholar
Lawn SD, Acheampong JW. Plmonary tuberculosis in adults: Factors associated with mortality at a Ghanian teaching hospital. West Afr J Med. 1999;18(4):270-274 PubMed/Google cholar
Yi-Chun Wu, Hsiu-Yun Lo, Siang-Lin Young, Da-Chen Chu, Pesus Chou. Comparing the factors correlated with Tuberculosis-Specific Deaths in Age Groups among tuberculosis-Related Deaths in Taiwan. PLos One. 2015;10(3):e0118929 2015 Mar 3 Doi:10.1371/journal.pone.0118929
Aisha L Adamu, Mukarara A Gadanya, Isa S Abubakar, Abubakar M Jibo, Musa M Bello, Auwalu U Gadija, Musa M Babashani, Ibrahim Abubakar. High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study. BMC Infectious. 6 (2017)17:170. DOI 10.1186/s12879-017-2249-4
Heunis T Y, Kiogozi J C, Chikobvu N G, Botha P, Rensburg S, Dingie HCJ. Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province. JO-BMC Public Health. SP-38Vl-1717 IS-1 AB 2017 http://doi.org/10.1186/s12889-16-3972-2
Hua Jianzhao, Susan Van den Hof, Xu Lin, Qiu Yubang, Hou Jinglong, MMarie J Van der Werf. Risk factors for non-cure among new sputum smear positive tuberculosis patients treated in tuberculosis dispensaries inYuhan, China. BMC Health Serv Res. 2011;11:97. doi:10.1186/1472-6963-11-97 PMCID:PMC3112400:PMID 21569305
E Namukwaya, F Nakwagala, F Mulekya, Mayanja-Kizza, S Mugerwa. Predictors of treatment failure among pulmonary tuberculosis patients in Mula go hospital, Uganda. African Health Sciences. 2011;11 (S1):S105-111
Amoran O E. Determinants of Treatment Failure Among tuberculosis Patients on Directly Observed Therapy in Rural Primary Health Care Centers in Ougun state, Nigeria. Primary Health Care: 2011. Open Access 1:104.doi:10.4172/2167-1079.1000104
Gilmour B, Xu Z, Bai L, Alene KA, Clements ACA. Risk factors associated with unsuccessful treatment outcomes in humans Province, China. Trop Med Intl Health. doi 2022 Mar;27(3):290-299. 10.1111/tmi.13720.Epub 2022 Feb 6.PMID:35014123;PMCID:PMC9305245
Sahile Z, Tezera R, Haile Marian D, Collins J, Ali JH. Nutritional status and TB treatmement outcomes in Adis Ababa, Ethiopia :An ambi-directional cohort study. PLOS ONE . 2021 16 (3): e0247945. Doi: 10.1371/journal.pone. 0247945
Van Lettow M, Kumwenda J J, Harries A D, Whalen C C, Taha T E, Kumwenda N Kang'ombe C, Semba R D. Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. The International Journal of Tuberculosis and Lung Disease, vol 8 Number 2 February 2004, pp.211-217(7)
Korn Feldacker H, Sahukar SB, Procter-Grey E, Kumar NP, West K, Kane K, Natrajan M, Li W, Babu S, Viswanathan V. Impact of diabetes and low Body Mass Index on Tuberculosis Treatment Outcomes. Clin Infect Dis. 2020 Dec 3;71(9):e392-e398. Doi :10.1093/cid/ciaa054.PMID:31955202;PMCID:PMC7713690.
Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F. Factors assciated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case -control study. BMC Public Health. 2011;11:696. PMID:21906291
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