Rakotondrasoa Sedera Radoniaina, Raherinandrasana Antso Hasina, Ramanarivo Norotiana, Ramontalambo Tantely Jenny, Randriananahirana Zina Antonio, Ravaoarisoa Lantonirina, Rakotonirina Julio
Faculty of Medicine of Antananarivo, Antananarivo, Madagascar.
National Institute of Public and Community Health (INSPC), Antananarivo, Madagascar.
Pan Afr Med J. 2023 Dec 13;46:104. doi: 10.11604/pamj.2023.46.104.41514. eCollection 2023.
Tuberculosis (TB) is a global public health issue, affecting Africa and Madagascar. Adverse outcomes following ineffective treatment are common. Previous studies conducted in similar settings have not adequately accounted for confounding factors. The objective of this study is to identify predictive factors that are associated with tuberculosis treatment outcomes in Madagascar.
a retrospective cohort study was conducted using registries of 628 outpatients with tuberculosis at the Analakely Hospital (CHUSSPA) in 2019. Univariate and multivariate logistic regression analyses were performed.
the study included 628 patients with a mean age of 37.19 ± 15.86 years and a sex ratio of 1.57. These patients were followed up for a total of 2886 person-months. Out of the 628, 517 achieved treatment success, while 31 patients died and 31 discontinued their treatment. The rates of treatment success, death, failure, and default were 82.3%, 4.9%, 0.2%, and 8.3% respectively. Female gender was found to be a predictor of treatment success area of responsibility adjusted odds ratio(AOR 1.67 [1.07-2.66]; p=0.026). Smear-negative pulmonary tuberculosis (SNPTB) was associated with a lower likelihood of treatment success (AOR 0.38 [0.23-0.65]; p<0.001) and was a common factor for default (AOR 3.17 [1.60-6.21]; p=0.001) and death (AOR=8.03 [3.01-23.72; p<0.001]). Extra-pulmonary TB was identified as a predictor of death (AOR 5.15 [1.99-14.95]; p=0.001).
the tuberculosis treatment indicators in this center have not yet met national and global targets. It is necessary to focus on early diagnosis, improving education, and implementing rigorous follow-up procedures for patients at high risk of adverse outcomes (SNPTB and extra-pulmonary tuberculosis(EPTB).
结核病是一个全球性的公共卫生问题，影响着非洲和马达加斯加。无效治疗后的不良后果很常见。以往在类似环境中进行的研究没有充分考虑混杂因素。本研究的目的是确定与马达加斯加结核病治疗结果相关的预测因素。
采用2019年阿纳拉凯利医院（CHUSSPA）628例结核病门诊患者的登记资料进行回顾性队列研究。进行了单因素和多因素逻辑回归分析。
该研究纳入了628例患者，平均年龄为37.19±15.86岁，性别比为1.57。这些患者总共随访了2886人月。在628例患者中，517例治疗成功，31例死亡，31例中断治疗。治疗成功率、死亡率、失败率和违约率分别为82.3%、4.9%、0.2%和8.3%。发现女性是治疗成功责任区调整优势比的预测因素（AOR 1.67[1.07 - 2.66]；p = 0.026）。涂片阴性肺结核（SNPTB）与治疗成功的可能性较低相关（AOR 0.38[0.23 - 0.65]；p < 0.001），并且是违约（AOR 3.17[1.60 - 6.21]；p = 0.001）和死亡（AOR = 8.03[3.01 - 23.72；p < 0.001]）的常见因素。肺外结核被确定为死亡的预测因素（AOR 5.15[1.99 - 14.95]；p = 0.001）。
该中心的结核病治疗指标尚未达到国家和全球目标。有必要关注早期诊断、加强教育，并对不良后果高危患者（SNPTB和肺外结核（EPTB））实施严格的随访程序。
