在埃塞俄比亚西南部，结核病患者中卡特叶使用的程度和预测因素：一项纵向研究。
Magnitude and predictors of khat use among patients with tuberculosis in Southwest Ethiopia: A longitudinal study.
机构信息
Department of Psychiatry, Jimma University, Jimma, Ethiopia.
Center for International Health, Ludwig Maximilian University, Munich, Germany.
出版信息
PLoS One. 2020 Jul 30;15(7):e0236154. doi: 10.1371/journal.pone.0236154. eCollection 2020.
INTRODUCTION
Tuberculosis (TB) is a leading cause of morbidity and mortality in low and middle-income countries. Substance use negatively affects TB treatment outcomes. Our recent study has found that khat use predicted poorer adherence to anti-TB medications. However, there is scarce longitudinal study on predictors of khat use among outpatients with TB, and this study aimed at addressing this research gap.
METHODS
From October 2017 to October 2018, 268 outpatients with tuberculosis on DOTs were enrolled in a longitudinal study from 26 health institutions in Southwest Ethiopia. Structured questionnaires translated into local languages (Afaan Oromoo and Amharic) were used to assess khat use. Patients were followed for six months, and data were collected on three occasions during the follow-up. A generalized linear mixed model was used to identify the relation between khat use and predictors. Model fitness was checked using the Bayesian Information Criterion (BIC). Odds ratio (OR) and 95% CI were used to describe the strength of association between the outcome variable and predictors.
RESULTS
The overall prevalence of khat use at baseline and first follow up was 39.2% while it was 37.3% at second follow up. Of this, 77.1% and 96.2% of them believed that khat use reduces the side effects of anti-TB medications and symptoms of tuberculosis respectively. In the final model, being male (aOR = 7.0, p-value = 0.001), being government employee (aOR = 0.03, p-value≤0.001) and presence of alcohol use disorders (AUD) (aOR = 2.0, p-value≤0.001) predicted khat use among outpatients with tuberculosis.
CONCLUSION
A considerable proportion of patients with TB used khat throughout DOTs and wrongly perceived that it had health benefits. The finding implies that all patients diagnosed with TB should be screened for khat use, and a particular emphasis should be given to males and individuals with a history of alcohol use. Moreover, further studies are needed to assess patients' beliefs regarding the benefits of khat use so that interventions can be developed.
引言
结核病（TB）是中低收入国家发病率和死亡率的主要原因。物质使用会对结核病治疗结果产生负面影响。我们最近的研究发现，阿拉伯茶的使用与抗结核药物的治疗依从性较差有关。然而，关于结核病门诊患者中阿拉伯茶使用的预测因素，纵向研究很少，本研究旨在填补这一研究空白。
方法
从 2017 年 10 月至 2018 年 10 月，在埃塞俄比亚西南部的 26 个卫生机构中，对 268 名接受直接观察治疗（DOT）的结核病门诊患者进行了一项纵向研究。使用翻译成当地语言（Afaan Oromoo 和阿姆哈拉语）的结构化问卷评估阿拉伯茶的使用情况。对患者进行了六个月的随访，在随访期间共收集了三次数据。使用广义线性混合模型来确定阿拉伯茶使用与预测因素之间的关系。使用贝叶斯信息准则（BIC）检查模型拟合度。使用比值比（OR）和 95%置信区间（CI）来描述结局变量与预测因素之间的关联强度。
结果
基线和第一次随访时阿拉伯茶使用的总患病率为 39.2%，第二次随访时为 37.3%。其中，77.1%和 96.2%的人分别认为阿拉伯茶的使用可以减少抗结核药物的副作用和结核病症状。在最终模型中，男性（OR = 7.0，p 值 = 0.001）、政府雇员（OR = 0.03，p 值≤0.001）和存在酒精使用障碍（AUD）（OR = 2.0，p 值≤0.001）预测了结核病门诊患者中阿拉伯茶的使用。
结论
相当一部分结核病患者在 DOT 期间使用了阿拉伯茶，并错误地认为它对健康有益。这一发现意味着所有诊断出结核病的患者都应该接受阿拉伯茶使用情况的筛查，应特别关注男性和有酒精使用史的个体。此外，还需要进一步研究评估患者对阿拉伯茶使用益处的看法，以便制定干预措施。
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