Department of Public Health, Collage of Medicine and Health Science, Wachemo University, Hossana, Ethiopia.
Department of Public Health, School of Health Science, Madda Walabu University, Bale Goba, Ethiopia.
PLoS One. 2021 May 6;16(5):e0250804. doi: 10.1371/journal.pone.0250804. eCollection 2021.
Drug resistance tuberculosis (DR-TB) patients' mortality and loss to follow-up (LTF) from treatment and care is a growing worry in Ethiopia. However, little is known about predictors of mortality and LTF among drug-resistant tuberculosis patients in Oromia region, Ethiopia. The current study aimed to identify predictors of mortality and loss to follow-up among drug resistance tuberculosis patients in Oromia Hospitals, Ethiopia.
A retrospective follow up study was carried out from 01 November 2012 to 31 December 2017 among DR-TB patients after calculating sample size using single proportion population formula. Mean, median, Frequency tables and bar charts were used to describe patients' characteristics in the cohort. The Kaplan-Meier curve was used to estimate the probability of death and LTF after the treatment was initiated. The log-rank test was used to compare time to death and time to LTF. The Cox proportional hazard model was used to determine predictors of mortality and LTF after DR-TB diagnosis. The Crude and adjusted Cox proportional hazard ratio was used to measure the strength of association whereas p-value less than 0.05 were used to declare statistically significant predictors.
A total of 406 DR-TB patients were followed for 7084 person-months observations. Among the patients, 71 (17.5%) died and 32 (7.9%) were lost to follow up (LTF). The incidence density of death and LTF in the cohort was 9.8 and 4.5 per 1000 person-months, respectively. The median age of the study participants was 28 years (IQR: 27.1, 29.1). The overall cumulative survival probability of patients at the end of 24 months was 77.5% and 84.5% for the mortality and LTF, respectively. The independent predictors of death was chest radiographic findings (AHR = 0.37, 95% CI: 0.17-0.79) and HIV serostatus 2.98 (95% CI: 1.72-5.19). Drug adverse effect (AHR = 6.1; 95% CI: 2.5, 14.34) and culture test result (AHR = 0.1; 95% CI: 0.1, 0.3) were independent predictors of LTF.
This study concluded that drug-resistant tuberculosis mortality and LTF remains high in the study area. Continual support of the integration of TB/HIV service with emphasis and work to identified predictors may help in reducing drug-resistant tuberculosis mortality and LTF.
在埃塞俄比亚，耐药结核病（DR-TB）患者的死亡率和治疗及护理期间的失访（LTF）率不断上升，令人担忧。然而，关于奥罗米亚地区耐药结核病患者的死亡率和 LTF 的预测因素知之甚少。本研究旨在确定奥罗米亚医院耐药结核病患者的死亡率和 LTF 的预测因素。
采用回顾性随访研究，于 2012 年 11 月 1 日至 2017 年 12 月 31 日对 DR-TB 患者进行研究，使用单比例人群公式计算样本量。采用均值、中位数、频数表和条形图描述队列中患者的特征。采用 Kaplan-Meier 曲线估计治疗开始后死亡和 LTF 的概率。采用对数秩检验比较死亡和 LTF 的时间。采用 Cox 比例风险模型确定 DR-TB 诊断后的死亡率和 LTF 的预测因素。采用粗比和调整后 Cox 比例风险比来衡量关联强度，而 p 值<0.05 则用于确定具有统计学意义的预测因素。
共对 406 例 DR-TB 患者进行了 7084 人月的随访观察。在这些患者中，有 71 人（17.5%）死亡，32 人（7.9%）失访。该队列的死亡率和 LTF 的发病率密度分别为每 1000 人月 9.8 和 4.5 例。研究参与者的中位年龄为 28 岁（IQR：27.1，29.1）。患者在 24 个月结束时的总体累积生存率分别为 77.5%和 84.5%。死亡的独立预测因素是胸部影像学检查结果（AHR = 0.37，95%CI：0.17-0.79）和 HIV 血清阳性率 2.98（95%CI：1.72-5.19）。药物不良反应（AHR = 6.1；95%CI：2.5，14.34）和培养试验结果（AHR = 0.1；95%CI：0.1，0.3）是 LTF 的独立预测因素。
本研究表明，研究地区的耐药结核病死亡率和 LTF 仍然很高。持续支持结核病/艾滋病综合服务，并强调和努力确定预测因素，可能有助于降低耐药结核病的死亡率和 LTF。
