尼日利亚西南部半城市地区一家三级医院中评估直接观察短程治疗（DOTS）方案的患者的结核病治疗结果及治疗中断情况

Tuberculosis treatment outcomes and interruption among patients assessing DOTS regimen in a tertiary hospital in semi-urban area of south-western Nigeria.

作者信息

Omotosho B A, Adebayo A M, Adeniyi B O, Ayodeji O O, Ilesanmi O S, Kareem A O, Akitikori O T, Erhabor G E

出版信息

Niger J Med. 2014 Jan-Mar;23(1):51-6.

Abstract

BACKGROUND

Tuberculosis remains one of the most infectious diseases worldwide especially with the HIV pandemic. It is a cause of high morbidity and mortality in developing countries including Nigeria. Reasons contributing to high morbidity and mortality include high defaulting rate and treatment interruption. Several studies had evaluated the treatment outcome of tuberculosis but there is paucity of published literature on the outcome of treatment interruption especially in this environment. This study thus assessed the outcome of treatments and interruption among patients assessing DOTS regimen in a tertiary hospital located in asemi urban area in south-western Nigeria.

METHODOLOGY

The study was a review of TB register of the federal medical centre, Owo from its inception in 2008 to 2011. All the patients that have completed at least one course of chemotherapy (defined as 8 months of anti-tuberculosis treatment- 2 months intensive phase and 6 months continuation phase) were included. Treatment outcome and interruption were defined in accordance with World Health Organisation (WHO) recommendations. Data were analysed with SPSS version 17.

RESULTS

A total of 400 patients were included. The mean age of patients was 36.8 +/- 16.8 years and 56.3% were male. Majority, (79.7%) were adults aged 19-64 years, 12.5% were in the paediatric age group and 7.8% were elderly. Less than half, 45.3% had TB/HIV co-infection. Regarding treatment outcome of tuberculosis, 75.5% were cured, 14.8% died, 4% relapsed and 3% defaulted. A little above one-fifth, 21 (5.3%) had treatment interruption among whom 9 (42.9%) were successfully traced and completed treatment. Significantly, higher proportion of those that had treatment interruption died, 54.1% compared with their counterpart, 14.9%, (p < 0.001) and had relapse. (14.3% versus 3.4%, p = 0.01).

CONCLUSION

A high rate of tracking failure among patients with treatment interruption was found in the study. In addition, mortality and morbidity were higher among patients with treatment interruption. A more concerted effort is needed in tracking/tracing patients with treatment interruption in orderto reduce morbidity and mortality among TB patients assessing treatment.

摘要

背景

结核病仍然是世界上传染性最强的疾病之一，尤其是在艾滋病大流行的情况下。在包括尼日利亚在内的发展中国家，结核病是导致高发病率和高死亡率的原因之一。导致高发病率和高死亡率的原因包括高违约率和治疗中断。多项研究评估了结核病的治疗结果，但关于治疗中断结果的已发表文献很少，尤其是在这种环境下。因此，本研究评估了尼日利亚西南部一个半城市地区的一家三级医院中接受直接观察短程治疗（DOTS）方案的患者的治疗结果和治疗中断情况。

方法

该研究回顾了奥沃联邦医疗中心自2008年成立至2011年的结核病登记册。纳入所有完成至少一个化疗疗程（定义为8个月的抗结核治疗——2个月强化期和6个月持续期）的患者。治疗结果和治疗中断按照世界卫生组织（WHO）的建议进行定义。数据用SPSS 17版进行分析。

结果

共纳入400名患者。患者的平均年龄为36.8±16.8岁，56.3%为男性。大多数（79.7%）为19至64岁的成年人，12.5%为儿童年龄组，7.8%为老年人。不到一半（45.3%）的患者合并感染结核和艾滋病病毒。关于结核病的治疗结果，75.5%治愈，14.8%死亡，4%复发，3%违约。略高于五分之一（21例，5.3%）的患者出现治疗中断，其中9例（42.9%）被成功追踪并完成治疗。值得注意的是，治疗中断的患者中死亡比例显著更高，为54.1%，而未中断治疗的患者为14.9%（p<0.001），且复发比例也更高（14.3%对3.4%，p = 0.01）。