Ukwaja K N, Ifebunandu N A, Osakwe P C, Alobu I
Department of Internal Medicine, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria.
Niger Postgrad Med J. 2013 Jun;20(2):125-9.
To evaluate tuberculosis treatment outcomes in a Nigerian tertiary-care setting and to identify factors associated with unsuccessful treatment outcome.
Retrospective audit of tuberculosis patients registered for treatment from January 2006 to December 2010 at Federal Medical Centre Abakaliki, Nigeria. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organisation (WHO). Analysis was conducted using SPSS. Multivariable logistic regression analysis were used to identify independent predictors for unsuccessful treatment outcome and statistical significance was taken as P <0.05.
A total of 671 patients (55% male, 45% female) with a mean age of 36.4 years were registered for treatment; 147 (22%) were smear-positive, 270 (40%) smear-negative and 254 (38%) had extra-pulmonary tuberculosis. Also, 189 (28.2%) of them were HIV positive and; 341 (51%) lived in a rural area. Overall, 387 patients (57.7%) had a successful treatment outcome and 284 (42.3%) had an unsuccessful treatment outcome. Of the patients with unsuccessful treatment outcome, 192 (67.6%) had defaulted, 55 (19.4%) had died, 3 (1%) had treatment failure and 34 (12%) were transferred-out. Nil significant change in trend of treatment success over the study period [P = 0.75 for trend]. In multivariable analysis, unsuccessful treatment was associated with older age (aOR = 2.3), rural residence (aOR = 2.1), smear negative PTB (aOR=1.6), being on retreatment (aOR 3.8), and HIV seropositivity (aOR=1.7).
Treatment success rate was poor; targeted measures should be considered to improve treatment success among identified high-risk groups.
评估尼日利亚一家三级医疗机构的结核病治疗效果，并确定与治疗效果不佳相关的因素。
对2006年1月至2010年12月在尼日利亚阿巴卡利基联邦医疗中心登记接受治疗的结核病患者进行回顾性审计。根据世界卫生组织（WHO）制定的指南评估六个治疗效果标准。使用SPSS进行分析。采用多变量逻辑回归分析确定治疗效果不佳的独立预测因素，统计学显著性以P<0.05为准。
共有671名患者（55%为男性，45%为女性）登记接受治疗，平均年龄为36.4岁；147名（22%）痰涂片阳性，270名（40%）痰涂片阴性，254名（38%）患有肺外结核病。此外，其中189名（28.2%）为HIV阳性；341名（51%）居住在农村地区。总体而言，387名患者（57.7%）治疗成功，284名（42.3%）治疗效果不佳。在治疗效果不佳的患者中，192名（67.6%）已违约，55名（19.4%）已死亡，3名（1%）治疗失败，34名（12%）已转出。在研究期间治疗成功率无显著变化趋势[趋势P=0.75]。在多变量分析中，治疗效果不佳与年龄较大（调整后比值比[aOR]=2.3）、农村居住（aOR=2.1）、痰涂片阴性肺结核（aOR=1.6）、再次治疗（aOR 3.8）和HIV血清学阳性（aOR=1.7）相关。
治疗成功率较低；应考虑采取针对性措施以提高已确定的高危人群的治疗成功率。
