埃塞俄比亚难民营的结核病：2014 至 2017 年的病例报告趋势、特征和治疗结果。
Tuberculosis (TB) in the refugee camps in Ethiopia: trends of case notification, profile, and treatment outcomes, 2014 to 2017.
机构信息
Inter-Governmental Authority on Development (IGAD), Djibouti, Djibouti.
Administration for Refugee and Returnee Affairs, Addis Ababa, Ethiopia.
出版信息
BMC Infect Dis. 2021 Feb 3;21(1):139. doi: 10.1186/s12879-021-05828-y.
BACKGROUND
Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to improve the effectiveness of TB programs. This study aimed to investigate trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia.
METHODS
In this retrospective cohort study, demographic and clinical data of all TB cases registered in 25 refugee camps in Ethiopia from January 2014 to December 2017 were extracted. Multivariate logistic regression was fitted to estimate odds ratios and corresponding 95% confidence intervals for the measure of association linked with factors significantly associated with unsuccessful treatment outcomes.
RESULTS
A total of 1553 TB cases, mean age 27.7 years, were registered from 2014 to 2017. Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in number of notified TB cases (138 to 588 cases), in percentage of EPTB (23.2 to 32.7%), in contribution of children to total TB cases (18.8 to 30.1%) and to EPTB (40.6 to 65.1%), and in proportion of bacteriologically confirmed new and relapse pulmonary cases (43.8 to 64.8%). Treatment success rates for all TB cases remained lower at 72.7-79.4%. On average 24.8% had unfavorable treatment outcome, including 11.5% not evaluated, 8.0% LTFU, 4.8% died and 0.5% treatment failed. Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive.
CONCLUSIONS
There was continuous increase in notified TB cases and in percentage of childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases increased overtime. TB treatment success remained lower than the national achievement in 2017 (96%) and global target (> = 90%), which needs improvement. The higher LTFU, not evaluated, and death suggests the need to strengthen adherence education and supervision. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives.
背景
难民群体中结核病的严重程度增加。监测结核病病例报告和治疗结果对于提高结核病规划的效果至关重要。本研究旨在调查埃塞俄比亚难民营中结核病病例报告和治疗结果的趋势，并探讨与治疗结果不良相关的因素。
方法
在这项回顾性队列研究中，从 2014 年 1 月至 2017 年 12 月，从埃塞俄比亚 25 个难民营中提取了所有登记的结核病病例的人口统计学和临床数据。采用多变量逻辑回归估计与治疗结果不良相关的因素与治疗结果不良之间的关联的比值比和相应的 95%置信区间。
结果
2014 年至 2017 年期间，共登记了 1553 例结核病病例，平均年龄为 27.7 岁。其中，54.7%为男性，27.7%为儿童（<15 岁），71.2%为肺结核（PTB），27.8%为非肺结核（EPTB），98.3%为新发病例和复发病例。2014 年至 2017 年期间：结核病病例报告数量持续增加（从 138 例增加到 588 例），EPTB 的比例从 23.2%增加到 32.7%，儿童在总结核病病例中的比例从 18.8%增加到 30.1%，在 EPTB 中的比例从 40.6%增加到 65.1%，新发病例和复发病例的细菌学确诊比例从 43.8%增加到 64.8%。所有结核病病例的治疗成功率仍然较低，为 72.7-79.4%。平均有 24.8%的病例治疗结果不良，其中包括 11.5%未评估、8.0%失访、4.8%死亡和 0.5%治疗失败。治疗结果不良与治疗前体重低于 40 公斤、年龄超过 45 岁和 HIV 阳性显著相关。
结论
结核病病例报告数量和儿童结核病比例持续增加。新发病例和复发病例的细菌学确诊比例随时间推移而增加。2017 年，结核病治疗成功率仍低于全国水平（96%）和全球目标（>90%），需要改进。较高的失访率、未评估率和死亡率表明需要加强依从性教育和监督。对于治疗前体重低于 40 公斤、年龄超过 45 岁和 HIV 阳性的患者，需要提供特殊的社会经济支持和监测。
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