埃塞俄比亚阿姆哈拉地区耐多药结核病患者治愈时间的生存分析。
Survival analysis of time to cure on multi-drug resistance tuberculosis patients in Amhara region, Ethiopia.
作者信息
Limenih Yigzaw Alemu, Workie Demeke Lakew
机构信息
Ethiopia Statistical Agency, Bahir Dar Branch, Bahir Dar, Ethiopia.
Statistics Department, Bahir Dar University, Bahir Dar, Ethiopia.
出版信息
BMC Public Health. 2019 Feb 7;19(1):165. doi: 10.1186/s12889-019-6500-3.
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) is caused by bacteria that are resistant to the most effective anti-tuberculosis drug. The MDR-TB is an increasing global problem and the spread of MDR-TB has different recovery time for different patients. Therefore, this study aimed to investigate the recovery time of MDR-TB patients in Amhara region, Ethiopia.
METHOD
A retrospective study was carried out in seven hospitals having MDR-TB treatment center of Amhara region, Ethiopia from September 2015 to February 2018. An accelerated failure time and parametric shared frailty models were employed.
RESULTS
The study revealed that the recovery time of MDR-TB patients in Amhara region was 21 months. Out of the total MDR-TB patients, 110 (35.4%) censored and 201 (64.6%) cured of MDR-TB. The clustering effect of frailty model was hospitals and the Weibull-gamma shared frailty model was selected among all and hence used for this study. The study showed that extra pulmonary MDR-TB patients had longer recovery time than that of seamier pulmonary MDR-TB patients in Amhara region, Ethiopia. According to this study, male MDR-TB patients, MDR-TB patients with co-morbidity and clinical complication were experiencing longer recovery time than that of the counter groups. This study also showed that MDR-TB patients with poor adherence had longer recovery time than those with good adherence MDR-TB patients.
CONCLUSION
Among different factors considered in this study, MDR-TB type, clinical complication, adherence, co-morbidities, sex, and smoking status had a significant effect on recovery time of MDR-TB patients in Amhara region, Ethiopia. In conclusion, the Regional and Federal Government of Ethiopia should take immediate steps to address causes of recovery time of MDR-TB patients in Amhara region through encouraging adherence, early case detection, and proper handling of drug-susceptibility according to WHO guidelines.
背景
耐多药结核病（MDR-TB）由对最有效的抗结核药物具有耐药性的细菌引起。耐多药结核病是一个日益严重的全球性问题，不同患者耐多药结核病的传播恢复时间各异。因此，本研究旨在调查埃塞俄比亚阿姆哈拉地区耐多药结核病患者的恢复时间。
方法
2015年9月至2018年2月，在埃塞俄比亚阿姆哈拉地区设有耐多药结核病治疗中心的七家医院开展了一项回顾性研究。采用了加速失效时间模型和参数共享脆弱模型。
结果
研究表明，阿姆哈拉地区耐多药结核病患者的恢复时间为21个月。在所有耐多药结核病患者中，110例（35.4%）被审查，201例（64.6%）耐多药结核病治愈。脆弱模型的聚类效应是医院，在所有模型中选择了威布尔-伽马共享脆弱模型并用于本研究。研究表明，埃塞俄比亚阿姆哈拉地区肺外耐多药结核病患者的恢复时间比肺部耐多药结核病患者更长。根据本研究，男性耐多药结核病患者、患有合并症和临床并发症的耐多药结核病患者的恢复时间比对照组更长。本研究还表明，依从性差的耐多药结核病患者的恢复时间比依从性好的耐多药结核病患者更长。
结论
在本研究考虑的不同因素中，耐多药结核病类型、临床并发症、依从性、合并症、性别和吸烟状况对埃塞俄比亚阿姆哈拉地区耐多药结核病患者的恢复时间有显著影响。总之，埃塞俄比亚地区和联邦政府应立即采取措施，根据世界卫生组织的指南，通过鼓励依从性、早期病例发现和正确处理药物敏感性，解决阿姆哈拉地区耐多药结核病患者恢复时间长的原因。
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