Getnet Fentabil, Sileshi Henok, Seifu Wubareg, Yirga Selam, Alemu Abere Shiferaw
Department of Public Health, College of Health Sciences, Jigjiga University, Jigjiga, Ethiopia.
Department of Medical Microbiology, School of Medicine, Jigjiga University, Jigjiga, Ethiopia.
BMC Infect Dis. 2017 Dec 12;17(1):762. doi: 10.1186/s12879-017-2882-y.
Treatment outcomes serve as proxy measures of the quality of tuberculosis treatment provided by the health care system, and it is essential to evaluate the effectiveness of Directly Observed Therapy-Short course program in controlling the disease, and reducing treatment failure, default and death. Hence, we evaluated tuberculosis treatment success rate, its trends and predictors of unsuccessful treatment outcome in Ethiopian Somali region where 85% of its population is pastoralist.
A retrospective review of 5 years data (September 2009 to August 2014) was conducted to evaluate the treatment outcome of 1378 randomly selected tuberculosis patients treated in Kharamara, Dege-habour and Gode hospitals. We extracted data on socio-demographics, HIV Sero-status, tuberculosis type, treatment outcome and year using clinical chart abstraction sheet. Tuberculosis treatment outcomes were categorized into successful (cured and/or completed) and unsuccessful (died/failed/default) according to the national tuberculosis guideline. Data was entered using EpiData 3.1 and analyzed using SPSS 20. Chi-square (χ) test and logistic regression model were used to reveal the predictors of unsuccessful treatment outcome at P ≤ 0.05 significance level.
The majority of participants was male (59.1%), pulmonary smear negative (49.2%) and new cases (90.6%). The median age was 26 years [IQR: 18-40] and HIV co-infection rate was 4.6%. The overall treatment success rate was 86.8% [95%CI: 84.9% - 88.5%]; however, 4.8%, 7.6% and 0.7% of patients died, defaulted and failed to cure respectively. It fluctuated across the years and ranged from 76.9% to 94% [p < 0.001]. The odds of death/failure [AOR = 2.4; 95%CI = 1.4-3.9] and pulmonary smear positivity [AOR = 2.3; 95%CI = 1.6-3.5] were considerably higher among retreatment patients compared to new counterparts. Unsuccessful treatment outcome was significantly higher in less urbanized hospitals [p < 0.001]. Treatment success rate had insignificant difference between age groups, genders, tuberculosis types and HIV status (P > 0.05).
This study revealed that the overall tuberculosis treatment success rate has realized the global target for 2011-2015. However, it does not guarantee its continuity as adverse treatment outcomes might unpredictably occur anytime and anywhere. Therefore, continual effort to effectively execute DOTS should be strengthened and special follow-up mechanism should be in place to monitor treatment response of retreatment cases.
治疗结果是衡量医疗系统所提供结核病治疗质量的替代指标，评估短程直接观察治疗方案在控制疾病、减少治疗失败、中断治疗和死亡方面的有效性至关重要。因此，我们评估了埃塞俄比亚索马里地区的结核病治疗成功率、其趋势以及治疗结果未成功的预测因素，该地区85%的人口为牧民。
对5年数据（2009年9月至2014年8月）进行回顾性分析，以评估在卡拉马拉、德格哈布尔和戈德医院接受治疗的1378例随机选择的结核病患者的治疗结果。我们使用临床病历摘要表提取了关于社会人口统计学、艾滋病毒血清学状态、结核病类型、治疗结果和年份的数据。根据国家结核病指南，结核病治疗结果分为成功（治愈和/或完成治疗）和未成功（死亡/失败/中断治疗）。数据使用EpiData 3.1录入，并使用SPSS 20进行分析。卡方（χ）检验和逻辑回归模型用于在P≤0.05显著性水平下揭示治疗结果未成功的预测因素。
大多数参与者为男性（59.1%），痰涂片阴性（49.2%），且为新发病例（90.6%）。中位年龄为26岁[四分位间距：18 - 40]，艾滋病毒合并感染率为4.6%。总体治疗成功率为86.8%[95%置信区间：84.9% - 88.5%]；然而，分别有4.8%、7.6%和0.7%的患者死亡、中断治疗和未治愈。该成功率随年份波动，范围为76.9%至94%[p < 0.001]。与新发病例相比，复治患者死亡/治疗失败的几率[AOR = 2.4；95%置信区间 = 1.4 - 3.9]和痰涂片阳性几率[AOR = 2.3；95%置信区间 = 1.6 - 3.5]显著更高。在城市化程度较低的医院，治疗结果未成功的比例显著更高[p < 0.001]。治疗成功率在年龄组、性别、结核病类型和艾滋病毒状态之间无显著差异（P > 0.05）。
本研究表明，总体结核病治疗成功率已实现2011 - 2015年的全球目标。然而，这并不能保证其持续性，因为不良治疗结果可能在任何时间、任何地点不可预测地出现。因此，应加强持续有效实施直接观察治疗的努力，并应建立特殊的随访机制以监测复治病例的治疗反应。
