在埃塞俄比亚，耐多药结核病患者失访及其相关因素：系统评价和荟萃分析。
Lost to follow-up and associated factors among patients with drug resistant tuberculosis in Ethiopia: A systematic review and meta-analysis.
机构信息
School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
出版信息
PLoS One. 2021 Mar 18;16(3):e0248687. doi: 10.1371/journal.pone.0248687. eCollection 2021.
BACKGROUND
One third of global antmicrobial resistance deaths are attributed to drug resistant tuberculosis. Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis. There is a gap in nationally representative reliable information on lost to follow-up among patients with drug-resistant tuberculosis in Ethiopia.
OBJECTIVE
To estimate the pooled prevalence and associated factors of lost to follow-up among patients with drug resistant tuberculosis in Ethiopia.
METHODS
Observational studies searched from PubMed, HINARI and CINAHL were screened for eligibility. After assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q and I2. The random effects meta-analysis model was employed to pull the prevalence of lost to follow-up. Sub-group analysis and meta regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's and Begg's tests. Sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The odds ratios were used to measure associations.
RESULTS
The review was performed among 11 studies of which 9 were cohort studies. The sample sizes ranged from 90 to 612 and comprised a total of 3,510 participants. The pooled prevalence of lost to follow-up was 8.66% (95% CI, 5.01-13.14) with a high heterogeneity (I2 = 93.49%, p<0.001). Pulmonary multi-drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients.
CONCLUSION
There was a high prevalence of lost to follow-up among multi-drug resistant tuberculosis patients in Ethiopia. Anatomical site of tuberculosis was a significant factor affecting lost to follow-up. Strengthening the health care system and patient education should be given a due emphasis.
REGISTRATION NUMBER
CRD42020153326; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=153326.
背景
全球三分之一的抗菌药物耐药死亡归因于耐药结核病。失访是获得性耐药结核病发展的原因之一。在埃塞俄比亚，耐药结核病患者失访的全国代表性可靠信息存在差距。
目的
估计埃塞俄比亚耐药结核病患者失访的 pooled 患病率和相关因素。
方法
从 PubMed、HINARI 和 CINAHL 中筛选符合条件的观察性研究。在评估研究质量后，使用清单提取数据。使用森林图、Q 和 I2 评估异质性。采用随机效应荟萃分析模型计算失访 pooled 患病率。进行亚组分析和荟萃回归以确定异质性的来源。使用漏斗图和 Egger 检验和 Begg 检验评估发表偏倚。进行敏感性分析以评估个别研究对总体估计的影响。使用比值比来衡量关联。
结果
共纳入了 11 项研究，其中 9 项为队列研究。样本量从 90 到 612 不等，共纳入了 3510 名参与者。失访 pooled 患病率为 8.66%（95%CI，5.01-13.14），存在高度异质性（I2=93.49%，p<0.001）。与肺外结核患者相比，肺多耐药结核患者失访的可能性降低 50%。
结论
埃塞俄比亚耐多药结核病患者失访率较高。结核病的解剖部位是影响失访的重要因素。应加强医疗保健系统和患者教育。
注册号
CRD42020153326；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=153326。
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