Mengesha Melkamu Merid, Gebremichael Mathewos Alemu, Watumo Desta, Hallström Inger Kristensson, Jerene Degu
Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
Hadiya Zone Health Department, Hosanna, Ethiopia.
PLOS Glob Public Health. 2022 Mar 10;2(3):e0000161. doi: 10.1371/journal.pgph.0000161. eCollection 2022.
Tuberculosis (TB) remains a major medical and public health problem throughout the world, especially in developing countries including Ethiopia. Its control program is currently being challenged by the spread of drug-resistant TB, which is the result of poor treatment outcomes. Hence, this study assessed poor adult TB treatment outcomes and associated factors in Gibe Woreda, Southern Ethiopia. An institution-based cross-sectional study was conducted from March 1, 2020 to March 30, 2020, using a standard checklist to review clinical charts of TB patients who enrolled on first-line TB treatment under DOTS between June 2016 and June 2019. Poor treatment outcomes constituted death during treatment, treatment failure, and loss to follow-up (LTFU). Descriptive statistics were used to describe the characteristics of study participants. A binary logistic regression model was fitted to identify factors influencing treatment outcome and adjusted odds ratios with a 95% confidence interval were reported. The statistical significance of all tests in this study was declared at P-value <5%. A total of 400 adult TB patients were participated. The mean age of study participants was 39.2±16.7 years, 55.5% were males and 79.8% were pulmonary tuberculosis cases. Regarding the treatment outcomes, 58% completed treatment, 27.5% cured, 9.3% were LTFU, 3.2% died, and 2.0% failed. The overall poor treatment outcome was 14.5% (95% CI: 11.1-17.9). Age (aOR = 1.02; 95%CI: 1.01-1.04), male gender (aOR = 1.82; 95% CI: 0.99-3.73), travel ≥ 10 kilometres to receive TB treatment (aOR = 6.55; 95% CI: 3.02-14.19), and lack of family support during the course of treatment (aOR = 3.03; 95% CI: 1.37-6.70), and bedridden baseline functional status (aOR = 4.40; 95% CI: 0.96-20.06) were factors associated with poor treatment outcome. Successful TB treatment outcome in this study area was below the national TB treatment success rate. To improve positive treatment outcomes, remote areas should be prioritized for TB interventions, and stakeholders in TB treatment and care should give special emphasis to adults over the age of 45 years, males, those who travel more than 10 kilometres to receive TB care, having bedridden baseline functional status and those who had no family support.
结核病（TB）仍然是全球主要的医学和公共卫生问题，尤其是在包括埃塞俄比亚在内的发展中国家。其防控计划目前正受到耐多药结核病传播的挑战，这是治疗效果不佳的结果。因此，本研究评估了埃塞俄比亚南部吉贝县成年结核病患者治疗效果不佳的情况及相关因素。2020年3月1日至3月30日进行了一项基于机构的横断面研究，使用标准检查表回顾了2016年6月至2019年6月期间在直接观察下短程治疗（DOTS）项目接受一线结核病治疗的患者的临床病历。治疗效果不佳包括治疗期间死亡、治疗失败和失访（LTFU）。采用描述性统计来描述研究参与者的特征。拟合二元逻辑回归模型以确定影响治疗效果的因素，并报告调整后的比值比及95%置信区间。本研究中所有检验的统计学显著性设定为P值<5%。共有400名成年结核病患者参与。研究参与者的平均年龄为39.2±16.7岁，55.5%为男性，79.8%为肺结核病例。关于治疗效果，58%完成治疗，27.5%治愈，9.3%失访，3.2%死亡，2.0%治疗失败。总体治疗效果不佳率为14.5%（95%CI：11.1 - 17.9）。年龄（调整后比值比[aOR]=1.02；95%CI：1.01 - 1.04）、男性（aOR = 1.82；95%CI：0.99 - 3.73）、前往接受结核病治疗的路程≥10公里（aOR = 6.55；95%CI：3.02 - 14.19）、治疗过程中缺乏家庭支持（aOR = 3.03；95%CI：1.37 - 6.70）以及卧床的基线功能状态（aOR = 4.40；95%CI：0.96 - 20.06）是与治疗效果不佳相关的因素。本研究地区结核病治疗的成功效果低于国家结核病治疗成功率。为改善治疗的积极效果，应优先在偏远地区开展结核病干预措施，结核病治疗和护理的利益相关者应特别关注45岁以上的成年人、男性、前往接受结核病护理路程超过10公里的人、有卧床基线功能状态的人以及没有家庭支持的人。
