1
|
Peptenatu D, Băloi AM, Andronic O, Bolocan A, Cioran N, Gruia AK, Grecu A, Panciu TC, Georgescu L, Munteanu I, Pistol A, Furtunescu F, Strâmbu IR, Ibrahim E, Băiceanu D, Popescu GG, Păduraru D, Jinga V, Mahler B. Spatio-Temporal Pattern of Tuberculosis Distribution in Romania and Particulate Matter Pollution Associated With Risk of Infection. GEOHEALTH 2024; 8:e2023GH000972. [PMID: 38638801 PMCID: PMC11025721 DOI: 10.1029/2023gh000972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 04/20/2024]
Abstract
The study proposes a dynamic spatio-temporal profile of the distribution of tuberculosis incidence and air pollution in Romania, where this infectious disease induces more than 8,000 new cases annually. The descriptive analysis for the years 2012-2021 assumes an identification of the structuring patterns of mycobacterium tuberculosis risk in the Romanian population, according to gender and age, exploiting spatial modeling techniques of time series data. Through spatial autocorrelation, the degree of similarity between the analyzed territorial systems was highlighted and the relationships that are built between the analysis units in spatial proximity were investigated. By modeling the geographical distribution of tuberculosis, the spatial correlation with particulate matter (PM2.5) pollution was revealed. The identification of clusters of infected persons is an indispensable step in the construction of efficient tuberculosis management systems. The results highlight the link between the distribution of tuberculosis, air pollution and socio-economic development, which requires a detailed analysis of the epidemiological data obtained in the national tuberculosis surveillance and control program from the perspective of geographical distribution.
Collapse
Affiliation(s)
- D. Peptenatu
- Faculty of GeographyResearch Center for Integrated Analysis and Territorial Management (CAIMT)University of BucharestBucharestRomania
- Graphit Innovation FactoryStr.Constantin BrancoveanuDrobeta Turnu SeverinRomâniaRomânia
| | - A. M. Băloi
- Faculty of GeographyResearch Center for Integrated Analysis and Territorial Management (CAIMT)University of BucharestBucharestRomania
- Graphit Innovation FactoryStr.Constantin BrancoveanuDrobeta Turnu SeverinRomâniaRomânia
- Faculty of Administration and BusinessUniversity of BucharestBucharestRomania
| | - O. Andronic
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - A. Bolocan
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - N. Cioran
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - A. K. Gruia
- Faculty of Administration and BusinessUniversity of BucharestBucharestRomania
| | - A. Grecu
- Faculty of Administration and BusinessUniversity of BucharestBucharestRomania
| | - T. C. Panciu
- Marius Nasta Institute of PneumologyBucharestRomania
| | - L. Georgescu
- Marius Nasta Institute of PneumologyBucharestRomania
| | - I. Munteanu
- Marius Nasta Institute of PneumologyBucharestRomania
| | - A. Pistol
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - F. Furtunescu
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - I. R. Strâmbu
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - E. Ibrahim
- Marius Nasta Institute of PneumologyBucharestRomania
| | - D. Băiceanu
- Marius Nasta Institute of PneumologyBucharestRomania
| | - G. G. Popescu
- Marius Nasta Institute of PneumologyBucharestRomania
| | - D. Păduraru
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - V. Jinga
- Carol Davila University of Medicine and PharmacyBucharestRomania
| | - B. Mahler
- Carol Davila University of Medicine and PharmacyBucharestRomania
| |
Collapse
|
2
|
Fufa DB, Diriba TA, Dame KT, Debusho LK. Competing risk models to evaluate the factors for time to loss to follow-up among tuberculosis patients at Ambo General Hospital. Arch Public Health 2023; 81:117. [PMID: 37357257 DOI: 10.1186/s13690-023-01130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND A major challenge for most tuberculosis programs is the inability of tuberculosis patients to complete treatment for one reason or another. Failure to complete the treatment contributes to the emergence of multidrug-resistant TB. This study aimed to evaluate the risk factors for time to loss to follow-up treatment by considering death as a competing risk event among tuberculosis patients admitted to directly observed treatment short course at Ambo General Hospital, Ambo, Ethiopia. METHODS Data collected from 457 tuberculosis patients from January 2018 to January 2022 were used for the analysis. The cause-specific hazard and sub-distribution hazard models for competing risks were used to model the outcome of interest and to identify the prognostic factors associated to treatment loss to follow-up. Loss to follow-up was used as an outcome measure and death as a competing event. RESULTS Of the 457 tuberculosis patients enrolled, 54 (11.8%) were loss to follow-up their treatment and 33 (7.2%) died during the follow up period. The median time of loss to follow-up starting from the date of treatment initiation was 4.2 months. The cause-specific hazard and sub-distribution hazard models revealed that sex, place of residence, HIV status, contact history, age and baseline weights of patients were significant risk factors associated with time to loss to follow-up treatment. The findings showed that the estimates of the covariates effects were different for the cause specific and sub-distribution hazard models. The maximum relative difference observed for the covariate between the cause specific and sub-distribution hazard ratios was 12.2%. CONCLUSIONS Patients who were male, rural residents, HIV positive, and aged 41 years or older were at higher risk of loss to follow-up their treatment. This underlines the need that tuberculosis patients, especially those in risk categories, be made aware of the length of the directly observed treatment short course and the effects of discontinuing treatment.
Collapse
Affiliation(s)
- Daba Bulto Fufa
- Department of Statistics, College of Natural Sciences, Jimma University, Jimma, Ethiopia
- Current address: Department of Statistics, Assosa University, Assosa, Ethiopia
| | - Tadele Akeba Diriba
- Department of Statistics, College of Natural Sciences, Jimma University, Jimma, Ethiopia.
| | - Kenenisa Tadesse Dame
- Department of Statistics, College of Natural Sciences, Jimma University, Jimma, Ethiopia
| | - Legesse Kassa Debusho
- Department of Statistics, College of Science, Engineering and Technology, University of South Africa, Christian de Wet Road and Pioneer Avenue, Private Bag X6 Florida, 1710, Johannesburg, South Africa
| |
Collapse
|
3
|
Tuberculosis Treatment Outcomes and Its Predictors among Tuberculosis Patients Registered at Tefera Hailu Memorial General Hospital, Sekota Town, Northeast Ethiopia: A Seven-Year Retrospective Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:4212312. [PMID: 36923155 PMCID: PMC10010884 DOI: 10.1155/2023/4212312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
Background Despite the availability of effective medications, tuberculosis (TB) continues to be a serious global public health problem, primarily affecting low and middle-income nations. Measuring and reporting TB treatment outcomes and identifying associated factors are fundamental parts of TB treatment. The goal of this study was to look at the outcomes of TB treatment and the factors that influence them in Sekota, Northeast Ethiopia. Materials and Methods A facility-based retrospective study was conducted in Tefera Hailu Memorial General Hospital, Sekota town, Northeast Ethiopia. All TB patients who registered in the TB log book and had known treatment outcomes at the treatment center between January 1, 2015, and December 30, 2021, were included in this study. The data was gathered utilizing a pretested structured data extraction format that comprised demographic, clinical, and treatment outcome characteristics. Data were entered, cleaned, and analyzed using SPSS version 25. Descriptive statistics and logistic regression analysis were employed. A p value of less than 0.05 was considered statistically significant. Results A total of 552 registered TB patients' data were reviewed. Of these, 49.6% were male, 94.4% were new cases, 64.9% were presented with pulmonary TB, and 18.3% were HIV positive. Regarding the treatment outcome, 11.6% were cured, 82.2% completed their treatment, 1.1% had failed treatment, 1.3% were lost to follow-up, and the remaining 3.8% died during the follow-up. The overall treatment success rate among TB patients was 93.8%. The maximum number of successful treatment outcomes was 94.9% in 2021, while the lowest was 86.7% in 2020. The pattern of successful treatment results changes with the number of years of treatment. In the current study, being a new TB patient (AOR = 1.75, 95% CI: 1.31-7.32) and being an HIV-negative patient (AOR = 2.64, 95% CI: 1.20-5.8) were factors independently associated with a successful treatment outcome. Conclusion The rate of successful TB treatment outcomes in the current study was satisfactory. This achievement should be maintained and enhanced further by developing effective monitoring systems and educating patients about medication adherence.
Collapse
|
4
|
Hasen Badeso M, Sani Kalil F, Mohammed Ahmed Y, Abdulkadir Godie S, Habtamu Regesu A. Trends of Tuberculosis Disease from 2013-2018 in Bale Zone, Oromia Region, Ethiopia. Retrospective Review. Infect Drug Resist 2022; 15:6723-6730. [PMID: 36438646 PMCID: PMC9697398 DOI: 10.2147/idr.s384402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Tuberculosis is a common global public health problem. Ethiopia is among the thirty top Tuberculosis burden countries. Trends of tuberculosis disease in general and at the district level in the Bale Zone have not been assessed and no adequate information existed for informed decision-making. This study was to describe the trends and physical distribution of the tuberculosis disease in the Bale Zone from 2013 to 2018. Methods We reviewed the reported data of tuberculosis from 2013 to 2018 in March 2019 and extracted data of tuberculosis from the Bale Zone health information system database. Analysis of the six-year data of tuberculosis was conducted after the data was cleaned and checked for completeness. Results We recruited a total of 11, 268 tuberculosis cases. The proportions of sputum smear-positive tuberculosis (SS+), sputum smear-negative tuberculosis (SS-), and extra-pulmonary tuberculosis (EPTB) cases were 40.4%, 29.6% and 30%, respectively. Of all cases, 81.9% are aged greater than 15 years. Prevalence of all types of tuberculosis was 0.005%, 0.127%, 0.133%, 0.136%, 0.131% and 0.093% in 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The death rate from positive pulmonary tuberculosis was 0%. 2.74, 2.10, 2.06, 1.04, and 2.75 in 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The highest average prevalence rate was 198, 152 and 142 per 100,000 populations in Berbere, Rayitu, and Gura-Dhamole Woreda, respectively. Conclusion The proportion of sputum smear-positive tuberculosis was high in the Bale Zone. Bale Zone should give more attention to the Tuberculosis program to tackle sputum smear positive. We recommended researchers investigate further research to identify determinants in districts with a high prevalence rate of tuberculosis.
Collapse
Affiliation(s)
- Mohammed Hasen Badeso
- Field Epidemiology Training Program, Jimma University Jimma, Jimma, Oromia Regional State, Ethiopia,Correspondence: Mohammed Hasen Badeso, Po.Box 61, Gindhir, Tel +251923728803, Email
| | - Falaho Sani Kalil
- Field Epidemiology Training Program, Jimma University Jimma, Jimma, Oromia Regional State, Ethiopia
| | - Yusuf Mohammed Ahmed
- Health Emergency, World Health Organization, Nekemte, Oromia Regional State, Ethiopia
| | | | | |
Collapse
|
5
|
Spatial Co-Clustering of Tuberculosis and HIV in Ethiopia. Diseases 2022; 10:diseases10040106. [PMID: 36412600 PMCID: PMC9680430 DOI: 10.3390/diseases10040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Tuberculosis (TB) and HIV are epidemiologically associated, and their co-dynamics suggest that the two diseases are directly related at the population level and within the host. However, there is no or little information on the joint spatial patterns of the two diseases in Ethiopia. The main objective of the current study was to assess the spatial co-clustering of TB and HIV cases simultaneously in Ethiopia at the district level. Methods: District-level aggregated data collected from the national Health Management Information System (HMIS) for the years 2015 to 2018 on the number of TB cases enrolled in directly observed therapy, short course (DOTS) who were tested for HIV and the number of HIV patients enrolled in HIV care who were screened for TB during their last visit to health care facilities were used in this study. The univariate and bivariate global and local Moran’s I indices were applied to assess the spatial clustering of TB and HIV separately and jointly. Results: The results of this study show that the two diseases were significantly (p-value <0.001) spatially autocorrelated at the district level with minimum and maximum global Moran’s I values of 0.407 and 0.432 for TB, 0.102 and 0.247 for HIV, and 0.152 and 0.251 for joint TB/HIV. The district-level TB/HIV spatial co-clustering patterns in Ethiopia in most cases overlapped with the hot spots of TB and HIV. The TB/HIV hot-spot clusters may appear due to the observed high TB and HIV prevalence rates in the hot-spot districts. Our results also show that there were low-low TB/HIV co-clusters or cold spots in most of the Afar and Somali regions, which consistently appeared for the period 2015−2018. This may be due to very low notifications of both diseases in the regions. Conclusions: This study expanded knowledge about TB and HIV co-clustering in Ethiopia at the district level. The findings provide information to health policymakers in the country to plan geographically targeted and integrated interventions to jointly control TB and HIV.
Collapse
|
6
|
Baluku JB, Nanyonjo R, Ayo J, Obwalatum JE, Nakaweesi J, Senyimba C, Lukoye D, Lubwama J, Ward J, Mukasa B. Trends of notification rates and treatment outcomes of tuberculosis cases with and without HIV co-infection in eight rural districts of Uganda (2015 - 2019). BMC Public Health 2022; 22:651. [PMID: 35382794 PMCID: PMC8981742 DOI: 10.1186/s12889-022-13111-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background The End TB Strategy aims to reduce new tuberculosis (TB) cases by 90% and TB-related deaths by 95% between 2015 – 2035. We determined the trend of case notification rates (CNRs) and treatment outcomes of TB cases with and without HIV co-infection in rural Uganda to provide an interim evaluation of progress towards this global target in rural settings. Methods We extracted retrospective programmatic data on notified TB cases and treatment outcomes from 2015 – 2019 for eight districts in rural Uganda from the District Health Information System 2. We estimated CNRs as the number of TB cases per 100,000 population. Treatment success rate (TSR) was calculated as the sum of TB cure and treatment completion for each year. Trends were estimated using the Mann–Kendall test. Results A total of 11,804 TB cases, of which 5,811 (49.2%) were HIV co-infected, were notified. The overall TB CNR increased by 3.7-fold from 37.7 to 141.3 cases per 100,000 population in 2015 and 2019 respectively. The increment was observed among people with HIV (from 204.7 to 730.2 per 100,000, p = 0.028) and HIV-uninfected individuals (from 19.9 to 78.7 per 100,000, p = 0.028). There was a decline in the TSR among HIV-negative TB cases from 82.1% in 2015 to 63.9% in 2019 (p = 0.086). Conversely, there was an increase in the TSR among HIV co-infected TB cases (from 69.9% to 81.9%, p = 0.807). Conclusion The CNR increased among people with and without HIV while the TSR reduced among HIV-negative TB cases. There is need to refocus programs to address barriers to treatment success among HIV-negative TB cases. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13111-1.
Collapse
Affiliation(s)
- Joseph Baruch Baluku
- Mildmay Uganda, Wakiso, Uganda. .,Makerere University Lung Institute, Kampala, Uganda.
| | | | | | | | | | | | - Deus Lukoye
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Joseph Lubwama
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jennifer Ward
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Kampala, Uganda
| | | |
Collapse
|
7
|
Ali MA, Balcha ES, Woldesemayat AA, Tirore LD. Combined assessment of tuberculosis case notification rate and infection control at health facilities of Dale districts, Sidama Zone, Southern Ethiopia. PLoS One 2021; 16:e0242446. [PMID: 34637447 PMCID: PMC8509858 DOI: 10.1371/journal.pone.0242446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mycobacterium tuberculosis (TB) is the deadliest disease that claims millions of deaths globally. Ethiopia is among the countries heavily hit by the disaster. Despite the effective directly observed treatment and TB infection control (TBIC) measures provided by the world health organization (WHO), the rate of new cases increased daily throughout the country. Healthcare workers (HCWs) are at highest risk serving without having the necessary facility in place while overcrowding of patients exacerbated TB transmission. The study aimed to assess TBIC implementation and analyze case notification rate (CNR) of smear-positive pulmonary TB in the selected health facilities at Dale district, Sidama Zone, Southern Ethiopia. Methods Seven health care facilities have been visited in the study area and smear-positive pulmonary TB notification rate was determined retrospectively during the years 2012 to 2014. Data on smear positive test results and demographic characteristics were collected from the TB unit registries. A structured questionnaire, facility survey, and observation checklists were used to assess the presence of TBIC plans at the health care facilities. Results The overall case notification rate of smear-positive pulmonary tuberculosis was 5.3% among all 7696 TB suspected patients. The odds of being diagnosed with smear-positive TB were 24% more in males than in females (adj OR = 1.24, 95% CI: (1.22, 1.55). Moreover, in the study area, only 28% of the facilities have been practiced TB infection control and 71% of the facilities assigned a focal person for the TBIC plan. The implementation of environmental control measures in the facilities was ranged between 16–83%. N95 particulate respirators were found only in 14% of the facilities. Conclusion TB CNR in Dale district was low. Moreover, implementations of TBIC in Dale district health facilities were poor when the survey was done. Hence, urgent measures should be taken to reverse the burden of TB.
Collapse
Affiliation(s)
- Makka Adam Ali
- Department of Oncology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Cellular and Molecular Biology, Faculty of Sciences, Addis Ababa University Addis Ababa, Ethiopia
- Department of Microbiology, Faculty of Medicine, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Ermias Sissay Balcha
- School of Medical Laboratory Science, College of Health Sciences, Hawassa University, Hawassa, Ethiopia
- * E-mail:
| | - Adugna Abdi Woldesemayat
- Department of Biotechnology, College of Biological and Chemical Engineering, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| | - Lopisso Dessalegn Tirore
- Department of Microbiology, Faculty of Medicine, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| |
Collapse
|
8
|
Woldesemayat EM, Azeze Z. Treatment outcome of tuberculosis at Dilla Referral Hospital, Gedeo Zone, southern Ethiopia: A retrospective study. PLoS One 2021; 16:e0249369. [PMID: 33793648 PMCID: PMC8016272 DOI: 10.1371/journal.pone.0249369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is one of the major public health problems in Ethiopia. Determining treatment outcome of TB cases could help to understand the effectiveness of TB control efforts. The objective of this study was to assess TB treatment outcome and associated factors and determine the risk factors of death among TB cases who were on Directly Observed Treatment Short course (DOTS). METHODOLOGY We analyzed a retrospective data for TB cases who were on DOTS at Dilla Referral Hospital from July 2011- June 2016. The study population was TB cases with known HIV status and whose treatment outcome was evaluated at the Hospital. Data were entered, cleaned and analyzed using statistical package SPSS for windows, version 20. RESULT Out of 899 registered TB cases, 731 included in this analysis. Of these cases, 424 (58.0%) were male and 334 (45.7%) were in the age group of below 25 years. Treatment success rate of TB was 675 (92.3%) and death rate was 18 (2.5%). Treatment outcome showed statistically significant variation by HIV status (P < 0.001). HIV status of the TB cases and pretreatment weight were associated with TB treatment outcome. HIV status of the TB cases was associated with death of the TB cases (Adjusted Odds Ratio (AOR) 5.0; CI 95%: 1.8-13.5). CONCLUSION TB treatment success rate found in this study was high. Patient's weight and HIV status were associated with treatment outcome. Moreover, HIV status predicted death of TB cases. Cautious treatment follow-up and defaulter tracing mechanisms for TB cases with these risk factors were suggested.
Collapse
Affiliation(s)
| | - Zewtir Azeze
- Digital Health Activity, John Snow Inc., Addis Ababa, Ethiopia
| |
Collapse
|
9
|
Taye H, Alemu K, Mihret A, Wood JL, Shkedy Z, Berg S, Aseffa A. Factors associated with localization of tuberculosis disease among patients in a high burden country: A health facility-based comparative study in Ethiopia. J Clin Tuberc Other Mycobact Dis 2021; 23:100231. [PMID: 33851036 PMCID: PMC8039820 DOI: 10.1016/j.jctube.2021.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A steady high rate of cervical tuberculous lymphadenitis (TBLN) has been reported in Ethiopia. That was significantly associated with biological factors that include age and sex of individuals. The risk of developing TBLN also related with chronic medical conditions such as renal disease. Suggests that specific symptom based screening may lead to missing a significant portion of cases. Hence, lymph node enlargement should be considered in the national case screening program.
Introduction In contrast to most tuberculosis (TB) high burden countries, Ethiopia has for a long time reported a very high percentage of extra pulmonary TB (EPTB), which is also reflected in population based estimations reported by the World Health Organization (WHO). Particularly a steadily higher proportion of cervical tuberculous lymphadenitis (TBLN) has been described. Here we identify clinical and demographic factors associated with anatomic site of the TB disease. Method A health facility based comparative study was conducted among TBLN and PTB patients who visited selected health facilities in Ethiopia during 2016 and 2017. Associated risk factors were identified through a multivariate logistic regression model using R-studio. Result A total of 1,890 study participants, 427 TBLN and 1,463 PTB patients, were included. The mean age of TBLN patients (29 years ± 14.4 SD) was lower than that of PTB cases (36 years ± 15.0 SD). There were slightly more women diagnosed with TBLN (51.1%) while nearly 6 out of 10 male patients were diagnosed with PTB (58.9%). Most significantly, younger age groups (<15 Years) were more likely to develop cervical TBLN than older people (>56 years), with an AOR of 9.76 (95% CI: 4.87, 19.56). The odds of cervical TBLN among women [1.69 (1.30, 2.20)] was higher than that for men. In addition, adjusted estimates suggested that, compared with PTB, renal diseases [3.41 (1.29, 9.02)] and the presence of other concomitant chronic illness [1.61 (1.23, 2.09)] had a significant association with TBLN. Conclusion Generally, the risk of developing a particular form of TB disease is usually associated with demographic and medical history of an infected individual. Hence, the current symptom based screening, which primarily rely on chronic cough in many countries, may lead to missing significant portions of TBLN cases.
Collapse
Affiliation(s)
- Hawult Taye
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Corresponding author at: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - James L.N. Wood
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Ziv Shkedy
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Biostatistics and Bioinformatics, University of Hasselt, Belgium
| | - Stefan Berg
- Bacteriology Department, Animal and Plant Health Agency, Weybridge, UK
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | |
Collapse
|
10
|
Dangisso MH, Datiko DG, Lindtjørn B. Identifying geographical heterogeneity of pulmonary tuberculosis in southern Ethiopia: a method to identify clustering for targeted interventions. Glob Health Action 2021; 13:1785737. [PMID: 32746745 PMCID: PMC7480636 DOI: 10.1080/16549716.2020.1785737] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Previous studies from Ethiopia detected disease clustering using broader geographic settings, but limited information exists on the spatial distribution of the disease using residential locations. An assessment of predictors of spatial variations of TB at community level could fill the knowledge gaps, and helps in devising tailored interventions to improve TB control. Objective To assess the pattern of spatial distribution of pulmonary tuberculosis (PTB) based on geographic locations of individual cases in the Dale district and Yirga Alem town in southern Ethiopia. Methods The socio-demographic characteristics of PTB cases were collected using a structured questionnaire, and spatial information was collected using geographic position systems. We carried out Getis and Ord (Gi*) statistics and scan statistics to explore the pattern of spatial clusters of PTB cases, and geographically weighted regression (GWR) was used to assess the spatial heterogeneities in relationship between predictor variables and PTB case notification rates (CNRs). Results The distribution of PTB varied by enumeration areas within the kebeles, and we identified areas with significant hotspots in various areas ineach year. In GWR analysis, the disease distribution showed a geographic heterogeneity (non-stationarity) in relation to physical access (distance to TB control facilities) and population density (AICc = 5591, R2 = 0.3359, adjusted R2 = 0.2671). The model explained 27% of the variability in PTB CNRs (local R2 ranged from 0.0002–0.4248 between enumeration areas). The GWR analysis showed that areas with high PTB CNRs had better physical accessibility to TB control facilities and high population density. The effect of physical access on PTB CNRs changed after the coverage of TB control facilities was improved. Conclusion We report a varying distribution of PTB in small and different areas over 10 years. Spatial and temporal analysis of disease distribution can be used to identify areas with a high burden of disease and predictors of clustering, which helps in making policy decisions and devising targeted interventions.
Collapse
Affiliation(s)
- Mesay Hailu Dangisso
- Department of Public Health, College of Medicine and Health Sciences, Hawassa University , Hawassa, Ethiopia
| | - Daniel Gemechu Datiko
- Department of Clinical Sciences, Liverpool School of Tropical Medicine , Liverpool, UK
| | - Bernt Lindtjørn
- Department of Public Health, College of Medicine and Health Sciences, Hawassa University , Hawassa, Ethiopia.,Centre for International Health, Faculty of Medicine, University of Bergen , Bergen, Norway
| |
Collapse
|
11
|
Mamo A, Mama M, Solomon D, Mohammed M. Treatment Outcomes and Predictors Among Tuberculosis Patients at Madda Walabu University Goba Referral Hospital, Southeast Ethiopia. Infect Drug Resist 2021; 13:4763-4771. [PMID: 33447062 PMCID: PMC7801921 DOI: 10.2147/idr.s285542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/11/2020] [Indexed: 02/01/2023] Open
Abstract
Background Tuberculosis (TB) remains a main public health threat worldwide. Over 90% of tuberculosis cases occur in low- and middle-income countries that have fragile health infrastructures and constrained resources available. Ethiopia ranks third in Africa and eighth of 22 from TB burdened countries globally. Case detection as early as possible and ensuring a successful treatment rate should be the main focus points to decrease the burden of TB. Objective To evaluate tuberculosis treatment outcomes and predictors among tuberculosis treatment follow-up patients at Madda Walabu University Goba Referral Hospital. Methods Retrospective document review was conducted among TB patients in the tuberculosis clinic at Goba Referral Hospital from January 1, 2015 to December 30, 2019. Data were analyzed using SPSS version 25.0. Descriptive and logistic regressions analyses were performed to identify the rate and predictors of tuberculosis treatment outcomes. The odds ratio and 95% confidence interval were calculated to check the association between variables. P ≤ 0.05 was considered statistically significant. Results The mean age of participants was 33.8 ± 17.3 years, and more than half of them (58.4%, 218) were males. From the total 373 participants, 65 (17.4%) registered TB patients were diagnosed HIV-positive. The overall success rate was 320 (91.2%) with [95% CI, 88–94.3]. Among these, 91 (25.9%) were cured and 229 (65.2%) completed treatment whereas 8.8% with [95% CI, 5.7–12] were unsuccessful treatment outcomes. Among them, the majority 18 (5.1%) died, 6 (1.7%) were moved to MDR-TB center, 4 (1.1%) were lost to follow-up and 3 (0.9%) were documented as treatment failed. Conclusion The treatment failure rate was 8.8% with [95% CI, 5.7–12]. The proportion of TB patents who died was relatively higher. HIV-positive patients and old age people were predictors of unsuccessful treatment outcomes. Thus, the health facility should strengthen the evaluation of HIV-positive patients and old age patients to minimize mortality.
Collapse
Affiliation(s)
- Ayele Mamo
- Department of Pharmacy, School of Medicine, Madda Walabu University Goba Referral Hospital, Bale Goba, Ethiopia
| | - Mohammedaman Mama
- Department of Medical Laboratory Science, School of Medicine, Madda Walabu University Goba Referral Hospital, Bale Goba, Ethiopia
| | - Damtew Solomon
- Department of Biomedical Science, School of Medicine, Madda Walabu University Goba Referral Hospital, Bale Goba, Ethiopia
| | - Mesud Mohammed
- Department of Pharmacy, School of Medicine, Madda Walabu University Goba Referral Hospital, Bale Goba, Ethiopia
| |
Collapse
|
12
|
Wang HR, Han C, Wang JL, Zhang YA, Wang MS. Risk Factor for Retreatment Episode on Admission Among TB Patients With Schizophrenia. Front Psychiatry 2021; 12:793470. [PMID: 34955934 PMCID: PMC8695840 DOI: 10.3389/fpsyt.2021.793470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The clinical characteristics of patients with tuberculosis (TB) and schizophrenia remain largely unknown. Furthermore, TB retreatment is associated with a poor outcome. Hence, we aimed to address the risk factors of TB retreatment in schizophrenia patients in this retrospective cohort. Methods: Between March 2005 and August 2020, patients diagnosed with schizophrenia and TB were included in the study. Patient characteristics, such as demographics, medical history, underlying diseases, symptoms, outcome, and lab examinations, were collected from medical records using a structured questionnaire. TB retreatment was defined as treatment failures and relapses. Subsequently, multivariate logistic regression was performed using variables selected based on prior findings as well as factors found to be associated with a retreatment episode in univariate analyses (p < 0.1). Results: A total of 113 TB patients with schizophrenia were included. Of them, 94 (83.2%) patients were classified as initial treatment group, and 19 (16.8%) were classified as retreatment group. The mean age was 53.0 ± 23.2 years, and males accounted for 61.9% of all cases. Multivariate analysis revealed that continuous antipsychotics treatment (OR = 0.226, 95% CI: 0.074, 0.693; p = 0.009) and extra-pulmonary TB (OR = 0.249, 95% CI: 0.080, 0.783; p = 0.017) were associated with the retreatment in TB patients with schizophrenia. Conclusion: Retreatment is a significant concern for TB patients with schizophrenia. To improve the current dilemma, continuous antipsychotics treatment is required, and increasing awareness of schizophrenia would reduce the disease burden.
Collapse
Affiliation(s)
- Hai-Rong Wang
- Department of Outpatient, Shandong Mental Health Center, Jinan, China
| | - Chao Han
- Department of Outpatient, Shandong Mental Health Center, Jinan, China
| | - Jun-Li Wang
- Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yan-An Zhang
- Department of Cardiovascular Surgery, Shandong Public Health Clinical Center, Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China
| | - Mao-Shui Wang
- Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, China.,Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Lab Medicine, Shandong Public Health Clinical Center, Cheeloo College of Medicine, Shandong University, Jinan, China
| |
Collapse
|
13
|
Pembi E, John S, Dumre SP, Ahmadu BU, Vuong NL, Ebied A, Mizukami S, Huy NT, Cuevas LE, Hirayama K. Impact of political conflict on tuberculosis notifications in North-east Nigeria, Adamawa State: a 7-year retrospective analysis. BMJ Open 2020; 10:e035263. [PMID: 32938590 PMCID: PMC7497531 DOI: 10.1136/bmjopen-2019-035263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We assessed the impact of political conflict (Boko Haram) on tuberculosis (TB) case notifications in Adamawa State in North-east Nigeria. DESIGN A retrospective analysis of TB case notifications from TB registers (2010-2016) to describe changes in TB notification, sex and age ratios by the degree of conflict by local government area. SETTING Adamawa State. PARTICIPANTS 21 076 TB cases notified. RESULTS 21 076 cases (62% male) were notified between 2010 and 2016, of which 19 604 (93%) were new TB cases. Areas affected by conflict in 2014 and 2015 had decreased case notification while neighbouring areas reported increased case notifications. The male to female ratio of TB cases changed in areas in conflict with more female cases being notified. The young and elderly (1-14 and >65 years old) had low notifications in all areas, with a small increase in case notifications during the years of conflict. CONCLUSION TB case notifications decreased in conflict areas and increased in areas without conflict. More males were notified during peace times and more female cases were reported from areas in conflict. Young and elderly populations had decreased case notifications but experienced a slight increase during the conflict years. These changes are likely to reflect population displacement and a dissimilar effect of conflict on the accessibility of services. TB services in conflict areas deserve further study to identify resilient approaches that could reach affected populations.
Collapse
Affiliation(s)
- Emmanuel Pembi
- Program for Nurturing Global Leaders in Tropical and Emerging Communicable Diseases, Graduate School of Biomedical Sciences, Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Stephen John
- Adamawa State Agency for the Control of HIV/AIDs, Yola, Nigeria
| | - Shyam Prakash Dumre
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
| | - Baba Usman Ahmadu
- Department of Pediatrics, Federal Medical Centre, Yola, Adamawa State, Nigeria
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Amr Ebied
- Therapeutic Department, Egyptian National Blood Transfusion Services, Cairo, Egypt
| | - Shusaku Mizukami
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
- Department of Immune Regulation, Shionogi Global Infectious Diseases Division (SHINE), Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
| | - Luis E Cuevas
- Department of International Health and Epidemiology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Sakamoto, Nagasaki, Japan
| |
Collapse
|
14
|
Sariem CN, Odumosu P, Dapar MP, Musa J, Ibrahim L, Aguiyi J. Tuberculosis treatment outcomes: a fifteen-year retrospective study in Jos-North and Mangu, Plateau State, North - Central Nigeria. BMC Public Health 2020; 20:1224. [PMID: 32781994 PMCID: PMC7422002 DOI: 10.1186/s12889-020-09289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/23/2020] [Indexed: 12/04/2022] Open
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, North-Central 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. Data were collected from 10,156 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 bivariate and multivariate 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. The factors associated with treatment success were gender, age, year of enrollment, and HIV status. Extrapulmonary TB was less likely associated with treatment success (AOR:95% CI- 0.72:0.61-0.84, p < 0.001). 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.
Collapse
Affiliation(s)
- Comfort Nanbam Sariem
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Plateau State, Jos, Nigeria.
| | - Patricia Odumosu
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, University of Jos, Plateau State, Jos, Nigeria
| | - Maxwell Patrick Dapar
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Jos, Plateau State, Jos, Nigeria
| | - Jonah Musa
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Jos, Plateau State, Jos, Nigeria
| | - Luka Ibrahim
- Department of Public Health, Ministry of Health, Plateau State, Jos, Nigeria
| | - John Aguiyi
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, University of Jos, Plateau State, Jos, Nigeria
| |
Collapse
|
15
|
Fentie AM, Jorgi T, Assefa T. Tuberculosis treatment outcome among patients treated in public primary healthcare facility, Addis Ababa, Ethiopia: a retrospective study. ACTA ACUST UNITED AC 2020; 78:12. [PMID: 32175083 PMCID: PMC7063765 DOI: 10.1186/s13690-020-0393-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/28/2020] [Indexed: 11/21/2022]
Abstract
Background Despite the availability of effective drugs, tuberculosis remains a major public health problem that predominantly affects low- and middle-income countries. This study aimed to assess tuberculosis treatment outcomes among patients treated at one of the primary health care levels in Addis Ababa, Ethiopia. Methods An institutional-based retrospective cross-sectional study was conducted at a tuberculosis clinic in public primary healthcare facility. The study populations were all patients with tuberculosis who had been completed their treatment course in the center from July 2014 to July 2018. After getting Ethical clearance and permission from the health center, trained data collectors working in the center were recruited. The collected data were checked for completeness every day by the principal investigators. Data were edited, cleaned, and analyzed using SPSS version 25. Descriptive statistics were used to summarize the data while multinomial logistic regression was employed to explore associations among variables of interest, and p < 0.05 was considered as statistically significant. Results A total of 352 patients with tuberculosis were included for the study with a median age of 25 years which ranged from 1 to79 year. Most (36.4%) participants were in the age group of 15 to 24 years. The majority (38.8%) of patients had extrapulmonary tuberculosis, 11.9% of them were HIV positive and only two had family history of tuberculosis. Regarding treatment outcome, 238(67.6%) completed the treatment, 95(27%) cured and the rest were unsuccessful treatment outcomes 19(5.4%) either died, defaulted or treatment failed. The odds ratio for cured in relation to unsuccessful treatment outcome was found to be significantly higher in HIV negative patients (AOR = 6.1; 95%CI 2.1–13.9) compared with those patients tested positive for HIV. While patients with smear-positive pulmonary tuberculosis (AOR = 10.5, 95% CI 5.36–16.31) were significantly associated with the odds of having complete treatment cure as compared to patients with extrapulmonary tuberculosis. Similarly being HIV positive and extrapulmonary tuberculosis were predicting factors for unsuccessful treatment compared with their counterparts. Conclusions The finding of the present study showed that successful tuberculosis treatment outcome was found to be optimal.
Collapse
Affiliation(s)
- Atalay Mulu Fentie
- 1School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tamrat Assefa
- 1School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
16
|
Datiko D, Hadgu A, Jerene D, Suarez PG. High urban tuberculosis case notification rates can be misleading: evidence from an urban setting in Ethiopia. BMC Public Health 2020; 20:302. [PMID: 32156265 PMCID: PMC7065328 DOI: 10.1186/s12889-020-8290-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) is a major public health problem. Its magnitude the required interventions are affected by changes in socioeconomic condition and urbanization. Ethiopia is among the thirty high burden countries with increasing effort to end TB. We aimed to describe the case notification rate (CNR) for urban tuberculosis (TB) and estimate the percentage of TB patients who are not from the catchment population. Methods This cross-sectional study used data from TB registers from 2014/15 to 2017/18. We calculated the CNR and treatment success rate for the study area. Results Of 2892 TB cases registered, 2432 (84%) were from Adama City, while 460 (16%) were from other sites. The total TB CNR (including TB cases from Adama and other sites) was between 153 and 218 per 100,000 population. However, the adjusted TB CNR (excluding cases outside Adama City) was lower, between 135 and 179 per 100,000. Of 1737 TB cases registered, 1652 (95%) were successfully treated. About 16% of TB cases notified contributing to CNR of 32 per 100,000 population is contributed by TB cases coming from outside of Adama city. The CNR of 32 per 100,000 population (ranging from 18 to 46 per 100,000) for Adama City was from the patients that came from the surrounding rural areas who sought care in the town. Conclusion Although the TB CNR in Adama City was higher than the national CNR, about one-fifth of TB cases came from other sites-which led to overestimating the urban CNR and underestimating the CNR of neighboring areas. TB programs should disaggregate urban TB case notification data by place of residence to accurately identify the proportion of missed cases.
Collapse
Affiliation(s)
- Daniel Datiko
- Challenge TB, Management Sciences for Health, Addis Ababa, Ethiopia.
| | - Ameha Hadgu
- Challenge TB, Management Sciences for Health, Addis Ababa, Ethiopia
| | - Degu Jerene
- Challenge TB, Management Sciences for Health, Addis Ababa, Ethiopia
| | | |
Collapse
|
17
|
Shaweno T, Getnet M, Fikru C. Does time to loss to follow-up differ among adult tuberculosis patients initiated on tuberculosis treatment and care between general hospital and health centers? A retrospective cohort study. Trop Med Health 2020; 48:9. [PMID: 32099523 PMCID: PMC7026974 DOI: 10.1186/s41182-020-00198-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients' loss to follow-up (LTFU) from tuberculosis treatment and care is a growing worry in Ethiopia. But, available information is inadequate in assessing the time to tuberculosis patient loss to follow-up difference between health centers and a general hospital in Ethiopia. We aimed to assess time to LTFU difference between health centers and a general hospital in rural Ethiopia. METHODS We conducted a retrospective cohort study from September 2008 to August 2015 and collected data from September 1 to October 02, 2016. A total of 1341 TB patients with known treatment outcomes were included into the study. Log rank test was used to compare the difference in time to TB patient loss to follow-up between health centers and a general hospital, whereas Cox proportional hazard model was used to assess factors associated with time to loss to follow-up in both settings. RESULTS We reviewed a total of 1341 patient records, and the overall follow-up time was 3074.7 and 3974 person months of observation (PMOs) for TB patients followed at health centers and a general hospital, respectively. The incidence of loss to follow-up rate was 27.3 per 1000 PMOs and 9.6 per 1000 PMOs, at health centers and a general hospital, respectively. From the overall loss to follow-ups that occurred, 55 (65.5%) and 33 (86.8%) of LTFUs occurred during the intensive phase and grew to 78 (92.9%) and 38 (100%) at health center and a general hospital, respectively, at the end of 6-month observation period. Older age (AOR = 1.7, 95%CI, 1.2-2.5, P < 0.001), being a rural resident (AHR = 2.7, 95%CI, 1.6-4.6), HIV reactive (AHR = 2.2, 95%CI, 1.5-3.2), following treatment and care in health center (AHR = 3.38, 95%CI, 2.06-5.53), and living at more than 10 km away from the health facility (AHR = 3.4, 95%CI, 2.1-5.7) were predictors for time to loss to follow-up among TB patients on treatment and care. CONCLUSION Time to TB patient loss to follow-up between health centers and a general hospital was significant. Loss to follow-up was high in patients with older age, rural residence, sero positive for HIV, living further from the health facilities, and following treatment and care at health centers. Strengthening the DOTs program with special emphasis on health centers is highly recommended.
Collapse
Affiliation(s)
- Tamrat Shaweno
- Department of Epidemiology, Faculty of Public Health, Jimma University Institute of Health, Jimma, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University Institute of Health, Jimma, Ethiopia
| | - Chaltu Fikru
- Department of Epidemiology, Faculty of Public Health, Jimma University Institute of Health, Jimma, Ethiopia
| |
Collapse
|
18
|
Singh H, Ramamohan V. A model-based investigation into urban-rural disparities in tuberculosis treatment outcomes under the Revised National Tuberculosis Control Programme in India. PLoS One 2020; 15:e0228712. [PMID: 32059003 PMCID: PMC7021308 DOI: 10.1371/journal.pone.0228712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
In this study, we investigate differences in tuberculosis (TB) treatment outcomes between urban and rural India and estimate their impact on epidemiological outcomes such as TB incidence, prevalence and mortality using a mathematical model of TB transmission dynamics. Publicly available district-level treatment outcomes data for new and previously treated TB cases was analyzed in conjunction with census data providing the proportion of urban population in each district to determine the effect of urbanity/rurality on treatment outcomes. Districts were grouped in clusters based on the proportion of urban population in each district, wherein the clusters were identified by applying machine learning methods. Regression analyses revealed that average treatment success rates among both new and previously treated cases decline with increase in the proportion of urban population in a district cluster, with substantially sharper declines in treatment success rates with degree of urbanity observed for previously treated cases. The impact of differences in treatment outcomes on epidemiological outcomes was estimated using a dynamic transmission model developed for this purpose. For example, the cluster with highest treatment success rates is projected to have an average of 3.2% fewer deaths per 100,000 population in comparison with the national average across 2019–24, and the cluster with the lowest treatment success rates has an average of 4.5% more deaths per 100,000 in comparison with the national average. We anticipate that these disparities in TB treatment outcomes and epidemiology between urban and rural India may motivate investigations into the associated causes and their redressal.
Collapse
Affiliation(s)
- Himanshu Singh
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Varun Ramamohan
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- * E-mail:
| |
Collapse
|
19
|
Humphrey JM, Mpofu P, Pettit AC, Musick B, Carter EJ, Messou E, Marcy O, Crabtree-Ramirez B, Yotebieng M, Anastos K, Sterling TR, Yiannoutsos C, Diero L, Wools-Kaloustian K. Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium. Open Forum Infect Dis 2020; 7:ofaa006. [PMID: 32010735 PMCID: PMC6984675 DOI: 10.1093/ofid/ofaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain. Methods We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed. Results In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death. Conclusions There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.
Collapse
Affiliation(s)
- John M Humphrey
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Philani Mpofu
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - April C Pettit
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Beverly Musick
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - E Jane Carter
- Department of Medicine, Brown University School of Medicine, Providence, Rhode Island, USA
| | - Eugène Messou
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Centre de Prise en Charge de Recherche et de Formation (Aconda-CePReF), Abidjan, Côte d'Ivoire
| | - Olivier Marcy
- University of Bordeaux, Centre INSERM U1219, Bordeaux Population Health, Bordeaux, France.,Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | - Marcel Yotebieng
- The Ohio State University, College of Public Health, Columbus, Ohio, USA
| | - Kathryn Anastos
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Timothy R Sterling
- Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Vanderbilt Tuberculosis Center, Nashville, Tennessee, USA
| | - Constantin Yiannoutsos
- Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Lameck Diero
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
20
|
Stosic M, Grujicic SS, Grgurevic A, Kuruc V, Ristic L, Antonijevic G, Jevtic M, Plavsa D, Vukicevic TA. Trends in tuberculosis notification and mortality and factors associated with treatment outcomes in Serbia, 2005 to 2015. Euro Surveill 2020; 25. [PMID: 31937395 PMCID: PMC6961260 DOI: 10.2807/1560-7917.es.2020.25.1.1900322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Previously a country with medium tuberculosis (TB) burden, Serbia almost reached a low TB burden during the period 2005 to 2015. Aim The aim of this study was to analyse the trends in notification rates and treatment success rates as well as to identify predictors of treatment outcomes. Methods We performed a trend analysis and logistic regression analysis of 17,441 TB cases registered from 2005 to 2015 in all health facilities in Serbia, to identify predictors of treatment success, loss to follow-up and mortality. Results From 2005 to 2015, TB notification rate and mortality in Serbia decreased but treatment success remained below the global target. Loss to follow-up was associated with retreatment (odds ratio (OR) = 2.38; 95% confidence interval (CI): 2.08–2.77), male sex (OR = 1.57; 95% CI: 1.39–1.79), age younger than 65 years (OR = 1.37; 95% CI: 1.20–1.51), lower education level (OR = 2.57; 95% CI: 1.74–3.80) and pulmonary TB (OR = 1.28; 95% CI: 1.06–1.56). Deaths were more frequent in retreatment cases (OR = 1.39; 95% CI: 1.12–1.61), male patients (OR = 1.34; 95% CI: 1.19–1.52), those 65 years and older (OR = 4.34; 95% CI: 4.00–5.00), those with lower education level (OR = 1.63; 95% CI: 1.14–2.33) and pulmonary TB (OR = 2.24; 95% CI: 1.78–2.83). Conclusions Special interventions should be implemented to address groups at risk of poor treatment outcome.
Collapse
Affiliation(s)
- Maja Stosic
- Public Health Institute of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
| | | | - Anita Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vesna Kuruc
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Lidija Ristic
- Clinic for Pulmonary Diseases, Clinical Center Nis, Nis, Serbia
| | | | - Miroslav Jevtic
- Special Hospital for Pulmonary Diseases Ozren-Sokobanja, Sokobanja, Serbia
| | - Dragana Plavsa
- Public Health Institute of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
| | | |
Collapse
|
21
|
Osei E, Oppong S, Adanfo D, Doepe BA, Owusu A, Kupour AG, Der J. Reflecting on tuberculosis case notification and treatment outcomes in the Volta region of Ghana: a retrospective pool analysis of a multicentre cohort from 2013 to 2017. Glob Health Res Policy 2019; 4:37. [PMID: 31890895 PMCID: PMC6916450 DOI: 10.1186/s41256-019-0128-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a petrified condition with a huge economic and health impact on families and health systems in Ghana. Monitoring of TB programme performance indicators can provide reliable data for direct measurement of TB incidence and mortality. This study reflects on the trends of TB case notification and treatment outcomes and makes comparison among 10 districts of the Volta region of Ghana. METHODS This was a retrospective analysis of surveillance data of a cohort of TB cases from 2013 to 2017. Trends of case notification and treatment outcomes were examined and compared. Logistic regression was used to determine the independent relationship between patients and disease characteristics and unsuccessful treatment outcomes. Odds ratios, 95% confidence intervals and p-values were estimated. RESULTS A gradual declining trend of case notification of all forms of TB was noticed, with an overall case notification rate (CNR) of 65 cases per 100,000 population during the period. A wide variation of case notification of TB was observed among the districts, ranging from 32 to 124 cases per 100,000 population. Similarly, treatment success rate decreased slightly from 83.1% during the first year to 80.2% in 2017, with an overall treatment success rate of 82.5% (95% CI: 81.3-83.8%). Treatment failure, death, and lost to follow up rates were 0.8% (range 0.5-1.2%), 13.5% (range 12.4-14.7%), and 3.1% (range 2.6-3.8%) respectively. The treatment success rate among districts ranged from 70.5% in South Tongu to 90.8% in Krachi West district. Returned after treatment interruption (Adjusted odds ratio [AOR]: 3.62; 95% CI: 1.66-7.91; P < 0.001) and TB/HIV co-infection (AOR: 1.94; 95% CI: 1.57-2.40; P < 0.001) predicts poor treatment outcomes. CONCLUSION Over the past five years, TB case notification and successful treatment outcomes did not significantly improve. Wide district variations in CNR was observed. The overall treatment success rate observed in this study is below the target of > 90% set by the World Health Organization's (WHO) end TB strategy. Additionally, patients who returned to continue treatment after interruption and those who were co-infected with HIV strongly predict unsuccessful treatment outcomes. Sustained interventions to prevent treatment interruptions and improved management of co-morbidities can enhance treatment outcomes, as required to achieve the elimination goal.
Collapse
Affiliation(s)
- Eric Osei
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Samuel Oppong
- Department of Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Daniel Adanfo
- Department of Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Bless Ativor Doepe
- Department of Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Andrews Owusu
- Department of Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Augustine Goma Kupour
- Department of Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Joyce Der
- Department of Epidemiology, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| |
Collapse
|
22
|
Rahimi BA, Rahimy N, Mukaka M, Ahmadi Q, Hayat MS, Wasiq AW. Determinants of treatment failure among tuberculosis patients in Kandahar City, Afghanistan: A 5-year retrospective cohort study. Int J Mycobacteriol 2019; 8:359-365. [PMID: 31793506 DOI: 10.4103/ijmy.ijmy_142_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tuberculosis (TB) is a preventable and treatable chronic disease. Afghanistan is among the high-TB-burden countries. The aim of this study is to find the determinants of treatment failure among TB patients in Kandahar City, Afghanistan. Methods This was a retrospective cohort study conducted in Kandahar City during a period of 5 years (August 2014-July 2019). For data analysis; descriptive statistics, Chi-square test, and logistic regression were used. Results Among 1416 TB patients, 894/1416 (63.1%) had pulmonary TB (PTB), whereas 522/1416 (36.9%) had extrapulmonary TB (EPTB). Mean age in these patients was 34.7 years while most of them were females in PTB (530/894 [59.3%]) and EPTB (340/522 [65.1%]) patients. Sputum smear was positive in 618/860 (71.9%) and 16/404 (4%) of PTB and EPTB patients, respectively. TB treatment failure was more in PTB (56/894 [6.3%]) than EPTB (4/522 [0.8%]). Chi-square test of TB cases showed that statistically significant determinants that may cause the treatment failure were re-treatment cases (crude odds ratio [COR] 7.7, P < 0.001), absence of fever (COR 5.2, P < 0.001), absence of cough (COR 1.7, P = 0.004), living in rural areas (COR 1.4, P = 0.035), and no weight loss (COR 1.3, P = 0.033). Binary logistic regression of the statistically significant variables revealed only absence of fever (adjusted odds ratio 6.0, P < 0.001) as the risk factor for treatment failure in TB patients. Conclusion TB is still a major threat for Kandahar City. Low treatment success rate and increased number of defaulted cases are the major threats.
Collapse
Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Paediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Najeebullah Rahimy
- Department of Histopathology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mavuto Mukaka
- Department of Clinical Trials Support Group, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Qudratullah Ahmadi
- Department of Surgery, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Mohammad Sami Hayat
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Abdul Wahed Wasiq
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| |
Collapse
|
23
|
Ma X, Mirutse G, Bayray A, Fang M. Tuberculosis treatment outcome: The case of women in Ethiopia and China, ten-years retrospective cohort study. PLoS One 2019; 14:e0219230. [PMID: 31738780 PMCID: PMC6860933 DOI: 10.1371/journal.pone.0219230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/14/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Every year tuberculosis kills above half million women all over the world. Nonetheless, the factor affecting TB treatment outcome of women was less frequently studied and compared among countries. Hence, this study was aimed to measure and compare outcome of treatment and the death size of these two countries. METHOD Socio demographic and clinical data of women treated for all form of tuberculosis in the past ten years 2007-2016 were collected from total of eight hospitals and six treatment centers of Tigray and Zigong respectively. Then, we measured the magnitude of TB, level of treatment success and identify factors associated with the unsuccessful TB outcome. RESULT In the past ten years, a total of 5603(41.5%) and 4527 (24.5%) tuberculosis cases were observed in Tigray and Zigong respectively. Of those with treatment outcome record a total of 2602(92%) in Tigray and 3916(96.7%) in Zigong were successfully treated. Total of 170 (6%) cases in Tigray and 36(0.8%) cases in Zigong were dead. In Tigray, retreatment cases (aOR, 0.29; 95% CI: 0.16-0.53) and MDR-TB cases (aOR, 0.31; 95% CI: 0.003, 0.27) were less likely to show treatment success. However,, HIV co-infected TB cases (aOR, 3.58; 95% CI: 2.47, 5.18) were more likely to show treatment success compared with unknown HIV status. In Zigong, women with MDR TB (aOR, 0.90; 95%CI: 0.24, 0.34) were less likely to show treatment success and women in the age category of 15-49 (aOR, 1.55; 95% CI: 1.08, 2.206) were more likely to show treatment success. CONCLUSION Big number of tuberculosis cases and death were observed in Tigray comparing with Zigong. Hence, a relevant measure should be considered to improve treatment outcome of women in Tigray regional state.
Collapse
Affiliation(s)
- Xiao Ma
- Department of Health-Related Social and Behavioral Science, West China School of Public Health, Sichuan University, Chengdu, China
| | - Gebremeskel Mirutse
- Schools of Public Health, College of Health Science, Mekelle University, Tigray, Ethiopia
| | - Alemayehu Bayray
- Schools of Public Health, College of Health Science, Mekelle University, Tigray, Ethiopia
| | - Mingwang Fang
- West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Abdullahi OA, Ngari MM, Sanga D, Katana G, Willetts A. Mortality during treatment for tuberculosis; a review of surveillance data in a rural county in Kenya. PLoS One 2019; 14:e0219191. [PMID: 31295277 PMCID: PMC6622488 DOI: 10.1371/journal.pone.0219191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 06/18/2019] [Indexed: 11/19/2022] Open
Abstract
Background Globally in 2016, 1.7 million people died of Tuberculosis (TB). This study aimed to estimate all-cause mortality rate, identify features associated with mortality and describe trend in mortality rate from treatment initiation. Method A 5-year (2012–2016) retrospective analysis of electronic TB surveillance data from Kilifi County, Kenya. The outcome was all-cause mortality within 180 days after starting TB treatment. The risk factors examined were demographic and clinical features at the time of starting anti-TB treatment. We performed survival analysis with time at risk defined from day of starting TB treatment to time of death, lost-to-follow-up or completing treatment. To account for ‘lost-to-follow-up’ we used competing risk analysis method to examine risk factors for all-cause mortality. Results 10,717 patients receiving TB treatment, median (IQR) age 33 (24–45) years were analyzed; 3,163 (30%) were HIV infected. Overall, 585 (5.5%) patients died; mortality rate of 12.2 (95% CI 11.3–13.3) deaths per 100 person-years (PY). Mortality rate increased from 7.8 (95% CI 6.4–9.5) in 2012 to 17.7 (95% CI 14.9–21.1) in 2016 per 100PY (Ptrend<0.0001). 449/585 (77%) of the deaths occurred within the first three months after starting TB treatment. The median time to death (IQR) declined from 87 (40–100) days in 2012 to 46 (18–83) days in 2016 (Ptrend = 0·04). Mortality rate per 100PY was 7.3 (95% CI 6.5–7.8) and 23.1 (95% CI 20.8–25.7) among HIV-uninfected and HIV-infected patients respectively. Age, being a female, extrapulmonary TB, being undernourished, HIV infected and year of diagnosis were significantly associated with mortality. Conclusions We found most deaths occurred within three months and an increasing mortality rate during the time under review among patients on TB treatment. Our results therefore warrant further investigation to explore host, disease or health system factors that may explain this trend.
Collapse
Affiliation(s)
| | | | - Deche Sanga
- Kilifi County TB Control Program, Kilifi, Kenya
| | - Geoffrey Katana
- Pwani University, Department of Public Health, Kilifi, Kenya
- Kilifi County Department of Public Health, Kilifi, Kenya
| | - Annie Willetts
- Pwani University, Department of Public Health, Kilifi, Kenya
| |
Collapse
|
25
|
Kirirabwa NS, Kimuli D, Nanziri C, Sama D, Ntudhu S, Okello DA, Byaruhanga R, Lukoye D, Kasozi S. A four-year trend in pulmonary bacteriologically confirmed tuberculosis case detection in Kampala-Uganda. BMC Pulm Med 2019; 19:91. [PMID: 31077178 PMCID: PMC6509788 DOI: 10.1186/s12890-019-0853-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management and control of pulmonary bacteriologically confirmed (PBC) tuberculosis (TB) also known as infectious TB is important not only to monitor for resistance but also to check for severity, treatment response and limit its spread. METHOD A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala district registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done. RESULTS Of the 10,404 records; 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. Sputum smear microscopy was the diagnostic test most commonly used 4905 (74.9%) followed by GeneXpert testing, 1023 (15.6%). Majority, 1951 (39.8%), of the PBC TB patients had a smear positivity grading of 3+ (> 10 acid-fast bacillus (AFB)/Fields). Public facilities diagnosed more PBC TB patients compared to private facilities, 3983 (60.8%) vs 2566 (39.2%). From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194 (p = 0.000). The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597(43%) to 890(40.6%) (p = 0.000) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015 (p = 0.000). The treatment success rate (TSR) for PBC TB patients improved from 69% in 2012 to 75.5% by end of 2015 (p = 0.001) with an improvement in cure rate from 52.3% to 62% (p = 0.000). There was an observed significant decrease in TB related mortality from 8.9 to 6.4% (p = 0.013). CONCLUSION The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics. A prospective study of PBC TB patients diagnosed with 3+ smear positivity grading may elucidate the reasons for the delay to diagnosis. Further, we propose a study of wider scope to estimate how many people a single PBC TB patient is likely to infect with TB before being diagnosed and treated.
Collapse
Affiliation(s)
| | - Derrick Kimuli
- TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda
| | - Carol Nanziri
- TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda
| | - Denis Sama
- TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda
| | - Syrus Ntudhu
- AIDS Information Centre (AIC), Musajja Alumbwa Road, Mengo, Kisenyi, Kampala, Uganda
| | - Daniel Ayen Okello
- Kampala Capital City Authority (KCCA), Public Health and Environment, Plot 1-3 Sir Apollo Kaggwa Road, Kampala, Uganda
| | - Raymond Byaruhanga
- TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda
| | - Deus Lukoye
- TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda
| | - Samuel Kasozi
- TRACK TB Project, Management Sciences for Health, Plot 15, Princess Anne Drive, Bugolobi, Kampala, Uganda
| |
Collapse
|
26
|
Tuberculosis Treatment Outcomes and Associated Factors among TB Patients Attending Public Hospitals in Harar Town, Eastern Ethiopia: A Five-Year Retrospective Study. Tuberc Res Treat 2019; 2019:1503219. [PMID: 31057963 PMCID: PMC6463571 DOI: 10.1155/2019/1503219] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/22/2019] [Accepted: 02/21/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Tuberculosis remains a major public health threat throughout the world particularly in developing countries. Evaluating the treatment outcome of tuberculosis and identifying the associated factors should be an integral part of tuberculosis treatment. Objectives The aim of this study was to assess the treatment outcome of tuberculosis and its associated factors among TB patients in the TB clinics of Harar public hospitals, Eastern Ethiopia, 2017. Methods A retrospective document review was conducted in two public hospitals of Harar town, located 516 km east of Addis Ababa. A systematic random sampling technique was used to select the document of TB patients who were registered in the hospitals from 1st of January, 2011, to 30th of December, 2015. The data were collected using a pretested structured data extraction format. SPSS Version 21 for window was used for data processing. Bivariate and multivariate analysis with 95% confidence interval was employed in order to infer the associations between TB treatment outcome and potential predictor variables. Results One thousand two hundred thirty-six registered TB patients' documents were reviewed. Of these, 59.8% were male, 94.2% were urban dwellers, 97% were new cases, 61.2% were presented with pulmonary TB, and 22.8% were HIV positive. Regarding the treatment outcome, 30.4% were cured, 62.1% completed their treatment, 3.9% died, 2.4% were defaulted, and the remaining 1.2% had failed treatment. The overall rate of the treatment success among the patients was 92.5%. In the present study, being female (AOR = 1.89, 95% CI: 1.14 - 3.14), having pretreatment weight of 20 – 29 kg (AOR = 11.03, 95% CI: 1.66 - 73.35), being HIV negative (AOR = 6.50, 95% CI: 3.95 - 10.71), and being new TB patient (AOR = 3.22 95% CI: 1.10 - 9.47) were factors independently associated with successful treatment outcome. On the other hand, being in the age group 54 – 64 years (AOR =10.41, 95% CI: 1.86 - 58.30) and age greater than 65 years (AOR =24.41, 95% CI: 4.19 - 142.33) was associated with unsuccessful TB treatment outcome. Conclusion In the current study, the rate of successful TB treatment outcome was acceptable. This rate should be maintained and further improved by designing appropriate monitoring strategies.
Collapse
|
27
|
Datiko DG, Guracha EA, Michael E, Asnake G, Demisse M, Theobald S, Tulloch O, Yassin MA, Cuevas LE. Sub-national prevalence survey of tuberculosis in rural communities of Ethiopia. BMC Public Health 2019; 19:295. [PMID: 30866870 PMCID: PMC6417109 DOI: 10.1186/s12889-019-6620-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/03/2019] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis is a major public health problem with varying prevalence in different settings. National prevalence surveys provide evidence for planning and decision making. However, they lack the capacity to estimate subnational magnitude that affected the capacity to make selected intervention based on the prevalence. Ethiopia is among high TB burden countries with estimated prevalence of 108 per 100,000 population varying by regions. We aimed to study sub national prevalence of smear-positive TB in rural communities of southern Ethiopia. Methods This cross-sectional study, enrolled community members aged over 14 years who had cough of at least two weeks duration. Two sputum samples were collected and examined by using smear microscopy. Results 38,304 eligible people were enumerated (10,779 from Hadiya, 10,059 from Gurage and 17,466 from Sidama) and indentified 960 presumptive cases. 16, 14 and 14 smear-positive pulmonary TB cases were identified respectively. The point prevalence of smear-positive TB were 148 per 100,000 population (95% CI: 91–241) in Hadiya, 139 per 100,000 population (95% CI: 83–234) in Gurage and 80/100,000 population (95%CI: 48–135) in Sidama zone. Gurage zone had the highest prevalent to notified cases of seven to one. Conclusions The prevalence of smear positive TB varies by districts and is high in rural southern Ethiopia compared to the estimated national prevalence. More TB patients remain missed and unreached, impacting negatively on health outcomes. TB case finding approaches should be revisited and innovative approaches and tools to identify missing people with TB should be scaled up.
Collapse
Affiliation(s)
- Daniel G Datiko
- REACH ETHIOPIA, Box 303, Hawassa, Ethiopia. .,Liverpool School of Tropical Medicine, Pembroke Place L5 3QA, Liverpool, UK.
| | | | | | | | - Meaza Demisse
- Addis Continental School of Public Health, Addis Ababa, Ethiopia
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place L5 3QA, Liverpool, UK
| | | | | | - L E Cuevas
- Liverpool School of Tropical Medicine, Pembroke Place L5 3QA, Liverpool, UK
| |
Collapse
|
28
|
Seid MA, Ayalew MB, Muche EA, Gebreyohannes EA, Abegaz TM. Drug-susceptible tuberculosis treatment success and associated factors in Ethiopia from 2005 to 2017: a systematic review and meta-analysis. BMJ Open 2018; 8:e022111. [PMID: 30257846 PMCID: PMC6169771 DOI: 10.1136/bmjopen-2018-022111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The main aim of this study was to assess the overall tuberculosis (TB) treatment success in Ethiopia and to identify potential factors for poor TB treatment outcome. DESIGN A systematic review and meta-analysis of published literature was conducted. Original studies were identified through a computerised systematic search using PubMed, Google Scholar and Science Direct databases. Heterogeneity across studies was assessed using Cochran's Q test and I2 statistic. Pooled estimates of treatment success were computed using the random-effects model with 95% CI using Stata V.14 software. RESULTS A total of 230 articles were identified in the systematic search. Of these 34 observational studies were eligible for systematic review and meta-analysis. It was found that 117 750 patients reported treatment outcomes. Treatment outcomes were assessed by World Health Organization (WHO) standard definitions of TB treatment outcome. The overall pooled TB treatment success rate in Ethiopia was 86% (with 95% CI 83%_88%). TB treatment success rate for each region showed that, Addis Ababa (93%), Oromia (84%), Amhara (86%), Southern Nations (83%), Tigray (85%) and Afar (86%). Mainly old age, HIV co-infection, retreatment cases and rural residence were the most frequently identified factors associated with poor TB treatment outcome. CONCLUSION The result of this study revealed that the overall TB treatment success rate in Ethiopia was below the threshold suggested by WHO (90%). There was also a discrepancy in TB treatment success rate among different regions of Ethiopia. In addition to these, HIV co-infection, older age, retreatment cases and rural residence were associated with poor treatment outcome. In order to further improve the treatment success rate, it is strategic to give special consideration for regions which had low TB treatment success and patients with TB with HIV co-infection, older age, rural residence and retreatment cases.
Collapse
|
29
|
Dangisso MH, Woldesemayat EM, Datiko DG, Lindtjørn B. Long-term outcome of smear-positive tuberculosis patients after initiation and completion of treatment: A ten-year retrospective cohort study. PLoS One 2018. [PMID: 29529036 PMCID: PMC5846790 DOI: 10.1371/journal.pone.0193396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The status of tuberculosis (TB) patients since initiation of treatment is unknown in South Ethiopia. The objective of this study was to assess the long-term outcomes of smear-positive TB patients since initiation and completion of treatment, which includes TB recurrence and mortality of TB patients. METHODS We did a retrospective cohort study on 2,272 smear-positive TB patients who initiated treatment for TB from September 1, 2002-October 10, 2012 in health facilities in Dale district and Yirgalem town administration. We followed them from the date of start of treatment to either the date of interview or date of death. RESULTS Recurrence rate of TB was 15.2 per 1000 person-years. Recurrence was higher for re-treatment cases (adjusted hazard ratio (aHR), 2.7; 95% CI, 1.4-5.3). Mortality rate of TB patients was 27.1 per 1,000 person-years. The risk was high for patients above 34 years of age (aHR, 2.1; 95% CI, 1.2-3.9), poor patients (aHR, 1.3; 95% CI, 1.0-1.8), patients with poor treatment outcomes (aHR, 6.7; 95% CI, 5.1-8.9) and for patients treated at least 3 times (aHR 4.8; 95% CI, 2.1-11.1). The excess mortality occurred among patients aged above 34 years was high (41.2/1000 person years). CONCLUSION High TB recurrence and death of TB patients was observed among our study participants. Follow-up of TB patients with the risk factors and managing them could reduce the TB burden.
Collapse
Affiliation(s)
- Mesay Hailu Dangisso
- Hawassa University, College of Medicine and Health Sciences, School of Public Health, Hawassa, Ethiopia
| | - Endrias Markos Woldesemayat
- Hawassa University, College of Medicine and Health Sciences, School of Public Health, Hawassa, Ethiopia
- University of Bergen, Faculty of Medicine, Centre for International Health, Bergen, Norway
- * E-mail:
| | - Daniel Gemechu Datiko
- HHA - REACH ETHIOPIA Project, Hawassa, Ethiopia
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bernt Lindtjørn
- Hawassa University, College of Medicine and Health Sciences, School of Public Health, Hawassa, Ethiopia
| |
Collapse
|
30
|
The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis. Int J Equity Health 2018; 17:4. [PMID: 29310659 PMCID: PMC5759183 DOI: 10.1186/s12939-017-0714-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 12/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful tuberculosis (TB) treatment is essential to effective TB control. TB-HIV coinfection, social determinants and access to services influenced by rural residence can affect treatment outcome. We examined the separate and joint effects of rural residence and HIV infection on poor treatment outcome among patients enrolled in a large TB treatment centre in Kano, Nigeria. METHODS We retrospectively analysed a cohort of patients with TB enrolled in a large urban TB clinic in northern Nigeria, from January 2010 to December 2014. Poor treatment outcome was defined as death, default or treatment failure. We used Poisson regression to model rates and determine the relative risks (and 95% confidence intervals, CI) of poor treatment outcomes. RESULTS Among 1381 patients included in the analysis, 28.4% were rural residents; 39.8% were HIV-positive; and 46.1% had a poor treatment outcome. Approximately 65 and 38% of rural and urban residents, respectively, had a poor treatment outcome. Rural residents had 2.74 times (95% CI: 2.27-3.29) the risk of having a poor treatment outcome compared to urban residents. HIV-positive patients had 1.4 times (95% CI: 1.16-1.69) the risk of poor treatment outcome compared to HIV-negative patients. The proportion of poor treatment outcome attributable to rural residence (population attributable fraction, PAF) was 25.6%. The PAF for HIV infection was 11.9%. The effect of rural residence on poor treatment outcome among HIV-negative patients (aRR:4.07; 95%CI:3.15-5.25) was more than twice that among HIV-positive patients (aRR:1.99; 95%CI:1.49-2.64). CONCLUSION Rural residents attending a large Nigerian TB clinic are at increased risk of having poor treatment outcomes, and this risk is amplified among those that are HIV-negative. Our findings indicate that rural coverage of HIV services may be better than TB services. These findings highlight the importance of expanding coverage of TB services to ensure prompt diagnosis and commencement of treatment, especially among rural-dwellers in resource-limited settings.
Collapse
|
31
|
Mwangwa F, Chamie G, Kwarisiima D, Ayieko J, Owaraganise A, Ruel TD, Plenty A, Tram KH, Clark TD, Cohen CR, Bukusi EA, Petersen M, Kamya MR, Charlebois ED, Havlir DV, Marquez C. Gaps in the Child Tuberculosis Care Cascade in 32 Rural Communities in Uganda and Kenya. J Clin Tuberc Other Mycobact Dis 2017; 9:24-29. [PMID: 29291251 PMCID: PMC5743212 DOI: 10.1016/j.jctube.2017.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Reducing tuberculosis (TB) deaths among children requires a better understanding of the gaps in the care cascade from TB diagnosis to treatment completion. We sought to assess the child TB care cascade in 32 rural communities in Uganda and Kenya using programmatic data. METHODS This is a retrospective cohort study of 160,851 children (ages <15 years) living in 12 rural communities in Kenya and 22 in Uganda. We reviewed national TB registries from health centers in and adjacent to the 32 communities, and we included all child TB cases recorded from January 1, 2013 to June 30, 2016. To calculate the first step of the child TB care cascade, the number of children with active TB, we divided the number of reported child TB diagnoses by the 2015 World Health Organization (WHO) child TB case detection ratio for Africa of 27%. The remaining components of the Child TB Care Cascade were ascertained directly from the TB registries and included: diagnosed with TB, started on TB treatment, and completed TB treatment. RESULTS In two and a half years, a total of 42 TB cases were reported among children living in 32 rural communities in Uganda and Kenya. 40% of the children were co-infected with HIV. Using the WHO child TB case detection ratio, we calculated that 155 children in this cohort had TB during the study period. Of those 155 children, 42 were diagnosed and linked to TB care, 42 were started on treatment, and 31 completed treatment. Among the 42 children who started TB treatment, reasons for treatment non-completion were loss to follow up (7%), death (5%), and un-recorded reasons (5%). Overall, 20% (31/155) of children completed the child TB care cascade. CONCLUSION In 32 rural communities in Uganda and Kenya, we estimate that 80% of children with TB fell off the care cascade. Reducing morbidity and mortality from child TB requires strengthening of the child TB care cascade from diagnosis through treatment completion.
Collapse
Affiliation(s)
| | - Gabriel Chamie
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Dalsone Kwarisiima
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Theodore D. Ruel
- University of California, San Francisco, Division Pediatric Infectious Diseases and Global Medicine, Department of Pediatrics, San Francisco, USA
| | - Albert Plenty
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Khai Hoan Tram
- Stanford University, School of Medicine, Palo Alto, CA, USA
| | - Tamara D. Clark
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Craig R. Cohen
- University of California, San Francisco, Department of Obstetrics and Gynecology, San Francisco, USA
| | | | - Maya Petersen
- University of California, Berkeley School of Public Health, Berkeley, United States
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, School of Medicine, Kampala, Uganda
| | - Edwin D. Charlebois
- Center for AIDS Prevention Studies, University of California, San Francisco, United States
| | - Diane V. Havlir
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Carina Marquez
- University of California, San Francisco, Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| |
Collapse
|
32
|
Datiko DG, Yassin MA, Theobald SJ, Cuevas LE. A community-based isoniazid preventive therapy for the prevention of childhood tuberculosis in Ethiopia. Int J Tuberc Lung Dis 2017; 21:1002-1007. [PMID: 28826449 PMCID: PMC5566998 DOI: 10.5588/ijtld.16.0471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 05/04/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although children in contact with adults with tuberculosis (TB) should receive isoniazid (INH) preventive therapy (IPT), this is rarely implemented. OBJECTIVE To assess whether a community-based approach to provide IPT at the household level improves uptake and adherence in Ethiopia. METHODS Contacts of adults with smear-positive pulmonary TB (PTB+) were visited at home and examined by health extension workers (HEWs). Asymptomatic children aged <5 years were offered IPT and followed monthly. RESULTS Of 6161 PTB+ cases identified by HEWs in the community, 5345 (87%) were visited, identifying 24 267 contacts, 7226 (29.8%) of whom were children aged <15 years and 3102 (12.7%) were aged <5 years; 2949 contacts had symptoms of TB and 1336 submitted sputum for examination. Ninety-two (6.9%) were PTB+ and 169 had TB all forms. Of 3027 asymptomatic children, only 1761 were offered (and accepted) IPT due to INH shortage. Of these, 1615 (91.7%) completed the 6-month course. The most frequent reason for discontinuing IPT was INH shortage. CONCLUSION Contact tracing contributed to the detection of additional TB cases and provision of IPT in young children. IPT delivery in the community alongside community-based TB interventions resulted in better acceptance and improved treatment outcome.
Collapse
Affiliation(s)
- D G Datiko
- REACH Ethiopia, Hawassa, Southern Region, Ethiopia, Liverpool School of Tropical Medicine, Liverpool, UK
| | - M A Yassin
- Liverpool School of Tropical Medicine, Liverpool, UK, The Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - S J Theobald
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - L E Cuevas
- Liverpool School of Tropical Medicine, Liverpool, UK
| |
Collapse
|
33
|
Marvi A, Asadi-Aliabadi M, Darabi M, Rostami-Maskopaee F, Siamian H, Abedi G. Silent changes of tuberculosis in Iran (2005-2015): A joinpoint regression analysis. J Family Med Prim Care 2017; 6:760-765. [PMID: 29564259 PMCID: PMC5848394 DOI: 10.4103/jfmpc.jfmpc_190_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction and Aim: Tuberculosis (TB) poses a severe risk to public health through the world but excessively distresses low-income nations. The aim of this study is to analyze silent changes of TB in Iran (2005–2015): A joinpoint regression analysis. Materials and Methods: This is a trend study conducted on all patients (n = 70) that register in control disease center of Joibar (one of coastal cities and tourism destination in Northern Iran which was recognized as an independent town since 1998) during 2005–2015. The characteristics of patients imported to the SPSS 19 and variation in incidence rate of different forms of pulmonary TB (PTB) (PTB+ or PTB–) and extra-PTB (EPTB)/year was analyzed. Variation in incidence rate of TB for male and female groups and different age groups (0–14, 15–24, 25–34, 35–44, 45–54, 55–64, and above 65 years) was analyzed, variation in trend of this diseases for different groups was compared in intended years, and also, variation in incidence rate of TB was analyzed by Joinpoint Regression Software. Results: The total number of TB was 70 cases during 2005–2015. The mean age of patients was 42.31 ± 21.26 years and median age was 40 years. About 71.4% of patients were PTB (55.7% for with PTB+ and 15.7% with PTB–) and rest of them (28.4%) were EPTB. In regard to classification of cases, 97.1% of them were new cases, 1.45% of them were relapsed cases, and 1.45% of them imported cases. In addition, history of hospitalization due to TB was observed in 44.3%. Conclusion: Despite recent developments of governmental health-care system in Iran and proper access to it and considering this fact that identification of TB cases with passive surveillance is possible. Hence, developing certain programs for sensitization of the covered population is essential.
Collapse
Affiliation(s)
- Abolfazl Marvi
- Department of Public Health, Student Research Committee, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehran Asadi-Aliabadi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Darabi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hasan Siamian
- Department of Medical Records (Health Information Technology), Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghasem Abedi
- Department of Public Health, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| |
Collapse
|
34
|
Pezzoli L, Gounder S, Tamani T, Daulako MR, Underwood F, Mainawalala S, Nawadra-Taylor V, Rafai E, Gillini L. Tuberculosis, Fiji, 2002-2013. Emerg Infect Dis 2016; 22:547-9. [PMID: 26890215 PMCID: PMC4766912 DOI: 10.3201/eid2203.151903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
During 2002–2013, a total of 1,890 tuberculosis cases were recorded in Fiji. Notification rates per 100,000 population increased from 17.4 cases in 2002 to 28.4 in 2013. Older persons were most affected, but tuberculosis also increased sharply in persons 25–44 years of age.
Collapse
|
35
|
Treatment outcome of new smear positive pulmonary tuberculosis patients in Hamadan, Iran: A registry-based cross-sectional study. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
36
|
Zenebe Y, Adem Y, Mekonnen D, Derbie A, Bereded F, Bantie M, Tulu B, Hailu D, Biadglegne F. Profile of tuberculosis and its response to anti-TB drugs among tuberculosis patients treated under the TB control programme at Felege-Hiwot Referral Hospital, Ethiopia. BMC Public Health 2016; 16:688. [PMID: 27485507 PMCID: PMC4969724 DOI: 10.1186/s12889-016-3362-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/23/2016] [Indexed: 11/29/2022] Open
Abstract
Background Tuberculosis (TB) is a global concern for both developing and developed countries. Currently it becomes more complex due to increasing levels of drug resistance and HIV co-infection. Delayed diagnosis and high case load are major factors contributing to continued transmission and failure to the treatment outcome. The study was conducted to determine the profile and treatment outcomes of TB patients at Felege-Hiwot Referral Hospital. Methods We analyzed the records of 1761 TB patients registered for treatment in Felege Hiwot Referral Hospital from July 2010 to June 2015. Data on patients’ socio-demographic characteristics, type of TB, HIV status and treatment outcome were analysed. Descriptive statistics and binary logistic regression models were used to present data. The odds ratio and the 95 % confidence intervals were calculated. A p-value of < 0.05 was considered statistical significant. Results The proportion of smear positive, smear-negative and extra-pulmonary TB were 205 (11.6 %), 548 (31.1 %) and 1008 (57.2 %), respectively. The overall treatment success rate accounts 542(80.8 %) with unsuccessful treatment of 129(19.2 %). The treatment outcome varied by the years from 68.9 to 97.4 %. Among tuberculosis patients, 459(26.1 %) of them were HIV positive. Being HIV positive (AOR = 4.29, 95 % CI, 2.20–8.37 P = 0.001), retreatment (AOR = 5.32, 95 % CI, 1.92–14.3, P = 0.001), rural residency (AOR = 18.0, 95 % CI, 9.06–37.82, P = 0.001) and the age group of 15–24 years (AOR = 2.91, 95%CI, 1.00–8.45, P = 0.04) showed statistical significant association for poor treatment outcome. Conclusions In the studied region, the overall treatment success rate was still below the WHO target of success rate, 85 %. However, the trend of treatment success rate showed a promising increment. Patients at high risk of unsuccessful treatment outcome should be identified early and given additional follow-up, medical intervention and social support.
Collapse
Affiliation(s)
- Yohannes Zenebe
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Yesuf Adem
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Awoke Derbie
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fetlework Bereded
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Begna Tulu
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Derese Hailu
- Bahir Dar Regional Health Research Laboratory Institute, Bahir Dar, Ethiopia
| | - Fantahun Biadglegne
- Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
37
|
Gebrezgabiher G, Romha G, Ejeta E, Asebe G, Zemene E, Ameni G. Treatment Outcome of Tuberculosis Patients under Directly Observed Treatment Short Course and Factors Affecting Outcome in Southern Ethiopia: A Five-Year Retrospective Study. PLoS One 2016; 11:e0150560. [PMID: 26918458 PMCID: PMC4769218 DOI: 10.1371/journal.pone.0150560] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) is one of the major public health and socio-economic issues in the 21st century globally. Assessment of TB treatment outcomes, and monitoring and evaluation of its risk factors in Directly Observed Treatment Short Course (DOTS) are among the major indicators of the performance of a national TB control program. Hence, this institution-based retrospective study was conducted to determine the treatment outcome of TB patients and investigate factors associated with unsuccessful outcome at Dilla University Referral Hospital, southern Ethiopia. Five years (2008 to 2013) TB record of TB clinic of the hospital was reviewed. A total 1537 registered TB patients with complete information were included. Of these, 942 (61.3%) were male, 1015 (66%) were from rural areas, 544 (35.4%) were smear positive pulmonary TB (PTB+), 816 (53.1%) were smear negative pulmonary TB (PTB-) and 177(11.5%) were extra pulmonary TB (EPTB) patients. Records of the 1537 TB patients showed that 181 (11.8%) were cured, 1129(73.5%) completed treatment, 171 (11.1%) defaulted, 52 (3.4%) died and 4 (0.3%) had treatment failure. The overall mean treatment success rate of the TB patients was 85.2%. The treatment success rate of the TB patients increased from 80.5% in September 2008-August 2009 to 84.8% in September 2012–May 2013. Tuberculosis type, age, residence and year of treatment were significantly associated with unsuccessful treatment outcome. The risk of unsuccessful outcome was significantly higher among TB patients from rural areas (AOR = 1.63, 95% CI: 1.21–2.20) compared to their urban counterparts. Unsuccessful treatment outcome was also observed in PTB- patients (AOR = 1.77, 95% CI: 1.26–2.50) and EPTB (AOR = 2.07, 95% CI: 1.28–3.37) compared to the PTB+ patients. In conclusion, it appears that DOTS have improved treatment success in the hospital during five years. Regular follow-up of patients with poor treatment outcome and provision of health information on TB treatment to patients from rural area is recommended.
Collapse
Affiliation(s)
- Gebremedhin Gebrezgabiher
- Jimma University, College of Health Sciences, P.O. Box 378, Jimma, Ethiopia
- Samara University, College of Veterinary Medicine, P.O. Box 132, Samara, Ethiopia
- * E-mail:
| | - Gebremedhin Romha
- Dilla University, College of Agriculture and Natural Resource, P.O. Box 419, Dilla, Ethiopia
| | - Eyasu Ejeta
- Wollega University, College of Health Sciences, P.O. Box 395, Nekemte, Ethiopia
| | - Getahun Asebe
- Gambella University, College of Agriculture and Natural Resource, P.O. Box 126, Gambella, Ethiopia
| | - Endalew Zemene
- Jimma University, College of Health Sciences, P.O. Box 378, Jimma, Ethiopia
| | - Gobena Ameni
- Addis Ababa University, Aklilu Lemma Institute of Pathobiology, P.O. Box 1176, Addis Ababa, Ethiopia
| |
Collapse
|
38
|
Dangisso MH, Datiko DG, Lindtjørn B. Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia. Glob Health Action 2015; 8:29443. [PMID: 26593274 PMCID: PMC4655224 DOI: 10.3402/gha.v8.29443] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the expansion of health services and community-based interventions in Ethiopia, limited evidence exists about the distribution of and access to health facilities and their relationship with the performance of tuberculosis (TB) control programmes. We aim to assess the geographical distribution of and physical accessibility to TB control services and their relationship with TB case notification rates (CNRs) and treatment outcome in the Sidama Zone, southern Ethiopia. DESIGN We carried out an ecological study to assess physical accessibility to TB control facilities and the association of physical accessibility with TB CNRs and treatment outcome. We collected smear-positive pulmonary TB (PTB) cases treated during 2003-2012 from unit TB registers and TB service data such as availability of basic supplies for TB control and geographic locations of health services. We used ArcGIS 10.2 to measure the distance from each enumeration location to the nearest TB control facilities. A linear regression analysis was employed to assess factors associated with TB CNRs and treatment outcome. RESULTS Over a decade the health service coverage (the health facility-to-population ratio) increased by 36% and the accessibility to TB control facilities also improved. Thus, the mean distance from TB control services was 7.6 km in 2003 (ranging from 1.8 to 25.5 km) between kebeles (the smallest administrative units) and had decreased to 3.2 km in 2012 (ranging from 1.5 to 12.4 km). In multivariate linear regression, as distance from TB diagnostic facilities (b-estimate=-0.25, p<0.001) and altitude (b-estimate=-0.31, p<0.001) increased, the CNRs of TB decreased, whereas a higher population density was associated with increased TB CNRs. Similarly, distance to TB control facilities (b-estimate=-0.27, p<0.001) and altitude (b-estimate=-0.30, p<0.001) were inversely associated with treatment success (proportion of treatment completed or cured cases). CONCLUSIONS Accessibility to TB control services improved despite the geographic variations. TB CNRs were higher in areas where people had better access to diagnostic and treatment centres. Community-based interventions also played an important role for the increased CNRs in most areas.
Collapse
Affiliation(s)
- Mesay Hailu Dangisso
- Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,School of Public and Environmental Health, College of Medicine and Health sciences, Hawassa University, Hawassa, Ethiopia.,Sidama Zone Health Department, Hawassa, Ethiopia;
| | - Daniel Gemechu Datiko
- HHA - REACH Ethiopia, Hawassa, Ethiopia.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bernt Lindtjørn
- Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| |
Collapse
|
39
|
Dangisso MH, Datiko DG, Lindtjørn B. Low case notification rates of childhood tuberculosis in southern Ethiopia. BMC Pediatr 2015; 15:142. [PMID: 26428086 PMCID: PMC4589978 DOI: 10.1186/s12887-015-0461-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 09/22/2015] [Indexed: 12/04/2022] Open
Abstract
Background Childhood tuberculosis (TB) is a public health concern causing considerable mortality. However, control of childhood TB receives little attention. The control efforts could be inadequate because of challenges associated with difficulties in diagnosing the disease in children. Understanding the burden of the disease among children is important to assess the ongoing transmission of the disease in a community and improving TB control efforts. This study was carried out to assess TB case notification rates (CNRs) and treatment outcomes in children aged less than 15 years over a ten-year period. Methods Data were collected from unit TB registers from all health facilities providing TB treatment in the Sidama Zone in Ethiopia. We analysed the CNRs and treatment outcomes by age category, gender, and place of residence. We used logistic regression analysis to identify factors associated with treatment outcomes and to control for confounding. Results A total of 4,656 cases of children less than 15 years of age were notified as diagnosed and treated for TB, constituting 13 % of all notified TB cases in the study area. The mean CNRs per 100,000 children less than 15 years were 30 for all new cases of TB, 28 for rural cases, 67 for urban cases, 28 in boys, and 32 in girls. The proportions of treatment success were 82 % for new and 77 % for retreatment cases for the entire study period and increased to 93 % for new cases in 2012 (X2trend, P < 0.001). Children less than five years old had a lower treatment success [adjusted odds ratio (AOR) 0.64 (95 % CI, 0.52-0.80)] and higher deaths [AOR 2 (95 % CI, 1.27–3.12)]. The proportion of children who died during treatment among children in the less than 2-year-old age group was three times higher than children in the 2 year and above age groups [AOR 3.34 (95 % CI, 1.92–5.82)]. Conclusion The CNRs of childhood TB were low in Sidama. Children less than 5 years old had a higher proportion of deaths. Efforts need to be made to improve the diagnosis and treatment of TB among children. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0461-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mesay Hailu Dangisso
- Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen Armauer Hansen Building, N-5012, Bergen, Norway. .,Sidama Zone Health Department, Hawassa, Ethiopia. .,Hawassa University, Hawassa, Ethiopia.
| | - Daniel Gemechu Datiko
- Hawassa University, Hawassa, Ethiopia. .,Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Bernt Lindtjørn
- Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen Armauer Hansen Building, N-5012, Bergen, Norway.
| |
Collapse
|
40
|
Correction: trends of tuberculosis case notification and treatment outcomes in the Sidama zone, Southern Ethiopia: ten-year retrospective trend analysis in urban-rural settings. PLoS One 2015; 10:e0125135. [PMID: 25875584 PMCID: PMC4395212 DOI: 10.1371/journal.pone.0125135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|