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Otchere ID, Asante-Poku A, Akpadja KF, Diallo AB, Sanou A, Asare P, Osei-Wusu S, Onyejepu N, Diarra B, Dagnra YA, Kehinde A, Antonio M, Yeboah-Manu D. Opinion review of drug resistant tuberculosis in West Africa: tackling the challenges for effective control. Front Public Health 2024; 12:1374703. [PMID: 38827613 PMCID: PMC11141065 DOI: 10.3389/fpubh.2024.1374703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 06/04/2024] Open
Abstract
Drug-resistant (DR) tuberculosis (TB) is a major public health concern globally, complicating TB control and management efforts. West Africa has historically faced difficulty in combating DR-TB due to limited diagnostic skills, insufficient access to excellent healthcare, and ineffective healthcare systems. This has aided in the emergence and dissemination of DR Mycobacterium tuberculosis complex (MTBC) strains in the region. In the past, DR-TB patients faced insufficient resources, fragmented efforts, and suboptimal treatment outcomes. However, current efforts to combat DR-TB in the region are promising. These efforts include strengthening diagnostic capacities, improving access to quality healthcare services, and implementing evidence-based treatment regimens for DR-TB. Additionally, many West African National TB control programs are collaborating with international partners to scale up laboratory infrastructure, enhance surveillance systems, and promote infection control measures. Moreso, novel TB drugs and regimens, such as bedaquiline and delamanid, are being introduced to improve treatment outcomes for DR-TB cases. Despite these obstacles, there is optimism for the future of DR-TB control in West Africa. Investments are being made to improve healthcare systems, expand laboratory capacity, and support TB research and innovation. West African institutions are now supporting knowledge sharing, capacity building, and resource mobilization through collaborative initiatives such as the West African Network for TB, AIDS, and Malaria (WANETAM), the West African Health Organization (WAHO), and other regional or global partners. These efforts hold promise for improved diagnostics, optimized treatment regimens, and provide better patient outcomes in the future where drug-resistant TB in WA can be effectively controlled, reducing the burden of the disease, and improving the health outcomes of affected individuals.
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Affiliation(s)
- Isaac Darko Otchere
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Adwoa Asante-Poku
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Awa Ba Diallo
- Biological Sciences Department, Faculty of Pharmacy at Cheikh Anta Diop University, Dakar, Senegal
| | - Adama Sanou
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | - Prince Asare
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Stephen Osei-Wusu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Nneka Onyejepu
- Microbiology Department, Center for Tuberculosis Research Laboratory, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Bassirou Diarra
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Martin Antonio
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Epidemic Preparedness and Response, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dorothy Yeboah-Manu
- Bacteriology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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Opito R, Kwenya K, Ssentongo SM, Kizito M, Alwedo S, Bakashaba B, Miya Y, Bukenya L, Okwir E, Onega LA, Kazibwe A, Othieno E, Kirya F, Olupot PO. Treatment success rate and associated factors among drug susceptible tuberculosis individuals in St. Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study. PLoS One 2024; 19:e0300916. [PMID: 38743721 PMCID: PMC11093355 DOI: 10.1371/journal.pone.0300916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is the leading cause of death among infectious agents globally. An estimated 10 million people are newly diagnosed and 1.5 million die of the disease annually. Uganda is among the 30 high TB-burdenedd countries, with Karamoja having a significant contribution of the disease incidence in the country. Control of the disease in Karamoja is complex because a majority of the at-risk population remain mobile; partly because of the nomadic lifestyle. This study, therefore, aimed at describing the factors associated with drug-susceptible TB treatment success rate (TSR) in the Karamoja region. METHODS This was a retrospective study on case notes of all individuals diagnosed with and treated for drug-susceptible TB at St. Kizito Hospital Matany, Napak district, Karamoja from 1st Jan 2020 to 31st December 2021. Data were abstracted using a customised data abstraction tool. Data analyses were done using Stata statistical software, version 15.0. Chi-square test was conducted to compare treatment success rates between years 2020 and 2021, while Modified Poisson regression analysis was performed at multivariable level to determine the factors associated with treatment success. RESULTS We studied records of 1234 participants whose median age was 31 (IQR: 13-49) years. Children below 15 years of age accounted for 26.2% (n = 323). The overall treatment success rate for the study period was 79.3%(95%CI; 77.0%-81.5%), with a statistically significant variation in 2020 and 2021, 75.4% (422/560) vs 82.4% (557/674) respectively, (P = 0.002). The commonest reported treatment outcome was treatment completion at 52%(n = 647) and death was at 10.4% (n = 129). Older age, undernutrition (Red MUAC), and HIV-positive status were significantly associated with lower treatment success: aPR = 0.87(95%CI; 0.80-0.94), aPR = 0.91 (95%CI; 0.85-0.98) and aPR = 0.88 (95%CI; 0.78-0.98); respectively. Patients who were enrolled in 2021 had a high prevalence of treatment success compared to those enrolled in 2020, aPR = 1.09 (95%CI; 1.03-1.16). CONCLUSION TB TSR in Matany Hospital was suboptimal. Older age, poor nutrition, and being HIV-positive were negative predictors of treatment success. We propose integrating nutrition and HIV care into TB programming to improve treatment success.
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Affiliation(s)
- Ronald Opito
- Department of Public Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Keneth Kwenya
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Saadick Mugerwa Ssentongo
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Mark Kizito
- Department of Internal Medicine, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Susan Alwedo
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Baker Bakashaba
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Yunus Miya
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Lameck Bukenya
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Eddy Okwir
- Directorate of Programs and Community Services, Baylor College of Health Sciences, Kampala, Uganda
| | - Lilian Angwech Onega
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Andrew Kazibwe
- Directorate of Program Management and Capacity Development, The AIDS Support Organization, Kampala, Uganda
| | - Emmanuel Othieno
- Department of Pathology, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Fred Kirya
- Department of Anatomy, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Peter Olupot Olupot
- Department of Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Mbale Clinical Research Institute, Mbale, Uganda
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Ngah VD, Rangoanana M, Fwemba I, Maama L, Maphalale S, Molete M, Ratikoane R, Ogunrombi M, Daramola J, Nyasulu PS. Evaluating determinants of treatment outcomes among tuberculosis patients in the mining district of Butha Buthe, Lesotho. IJID REGIONS 2022; 6:62-67. [PMID: 36593894 PMCID: PMC9797408 DOI: 10.1016/j.ijregi.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
Background Before the COVID-19 pandemic, tuberculosis (TB) was the leading infectious cause of death globally. In low- and middle-income countries (LMIC) including Lesotho, treatment outcome is lower than the recommended rate and poor TB treatment outcomes remain a programmatic challenge. The aim of this study was to determine unfavourable treatment outcomes and associated risk factors among TB patients in Butha Buthe district. Methods This was a retrospective record review of TB patients registered between January 2015 and December 2020. Data were collected from TB registers and patients' files and entered Microsoft Excel 2012. Analysis was conducted using R and INLA statistical software. Descriptive statistics were presented as frequencies and percentages. The differences between groups were compared using Pearson's X 2 test in bivariate analysis. Frailty Cox proportional hazards model was used to determine the risk of unfavourable outcomes among the variables. Results A total of 1792 TB patients were enrolled in the study with about 70% males (1,257). Majority (71.7%) of the patients were between 20 and 59 years old, with 48% of the patients being unemployed. Almost a quarter of the patients (23.1%) had unfavourable outcomes with death (342 patients) being the most common unfavourable outcome. Our study has shown that patients older than 59 years, and unemployment increased the risk of having unfavourable treatment outcomes. Death was the most common unfavourable outcome followed by lost-to-follow up. We also observed that the patients in the initiation phase of treatment died at a faster rate compared to those in the continuation phase (p=0.02). Conclusion TB treatment programs should have efficient follow-up methods geared more toward elderly patients. Active case finding to identify population at risk should be part of a TB program which would improve early diagnosis and treatment initiation. Patients in the intensive phase of the treatment program should be monitored more closely to determine adverse drug effects and nutritional requirement to prevent death during this phase of treatment.
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Affiliation(s)
- Veranyuy D. Ngah
- Division of Epidemiology and Biostatistics, Faculty of Medicine, and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Motlatsi Rangoanana
- Division of Epidemiology and Biostatistics, Faculty of Medicine, and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Isaac Fwemba
- Division of Epidemiology and Biostatistics, Faculty of Medicine, and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Llang Maama
- Disease Control Directorate, National Tuberculosis Program, Ministry of Health Lesotho
| | - Sele Maphalale
- District Health Management team Butha Buthe, Ministry of Health Lesotho National Tuberculosis Program, Ministry of Health Lesotho
| | - Mabatho Molete
- District Health Management team Butha Buthe, Ministry of Health Lesotho National Tuberculosis Program, Ministry of Health Lesotho
| | - Retselisitsoe Ratikoane
- District Health Management team Butha Buthe, Ministry of Health Lesotho National Tuberculosis Program, Ministry of Health Lesotho
| | - Modupe Ogunrombi
- Department of Clinical Pharmacology, Sefako Makgatho Health Sciences University, Pretoria South Africa
| | - Justine Daramola
- Department of Information Technology, Faculty of Informatics and Design, Cape Peninsula University of Technology
| | - Peter S. Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine, and Health Sciences, Stellenbosch University, Cape Town, South Africa,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Corresponding Author:
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