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埃塞俄比亚西部奥罗米亚州内克姆特公共医疗机构中接受抗结核治疗患者的治疗中断发生率及预测因素

Incidence and predictors of treatment interruption among patients on anti-tuberculosis treatment in Nekemte public healthcare facilities, Oromia, Western Ethiopia.

作者信息

Getachew Robsan Gudeta, Tolossa Tadesse, Teklemariam Zelalem, Ayele Angefa, Roba Hirbo Shore

机构信息

Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.

School of Medical Laboratory Sciences, College Health and Medical Sciences, Haramaya University, Harar, Ethiopia.

出版信息

Front Epidemiol. 2023 Dec 4;3:1234865. doi: 10.3389/fepid.2023.1234865. eCollection 2023.

Abstract

INTRODUCTION

Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021.

METHODS

A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model.

RESULTS

A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption.

CONCLUSION

A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions.

摘要

引言

结核病治疗中断会增加治疗效果不佳和耐药结核病发生的风险。然而,在埃塞俄比亚以及研究地区,关于结核病治疗中断的发生率和预测因素的数据仍然很少。因此,本研究旨在评估2017年7月1日至2021年6月30日期间,埃塞俄比亚西部奥罗米亚地区内克梅特公共卫生设施中接受结核病治疗患者的治疗中断发生率及预测因素。

方法

对研究期间纳入抗结核治疗的800名患者进行回顾性队列研究设计。数据收集自2017年7月1日至2021年6月30日期间登记接受治疗的患者病历卡。使用Epidata 3.2进行数据录入,使用STATA 14进行分析。采用具有95%置信区间(CI)和调整后风险比(AHR)的多变量Cox回归模型,以确定P值<0.05时的显著预测因素。最后,使用对数似然比和Cox-Snell残差图来检验模型的充分性。

结果

共对800名患者进行了随访,中位随访时间为2.3(95%CI:2.20 - 2.36)个月,最长随访时间为11.7个月。治疗中断的总体发生率为每1000人月观察值27.4例(95%CI:22.8 - 32.8)。18 - 34岁(AHR = 1.8,95%CI:1.02 - 3.18)、男性(AHR = 1.63,95%CI:1.1 - 2.42)、农村居民(AHR = 3,95%CI:1.98 - 4.64)、存在合并症(AHR = 10,95%CI:5.47 - 18.27)以及在治疗随访中缺乏治疗支持者(AHR = 2.82,95%CI:1.9 - 4.41)被发现是治疗中断的显著预测因素。

结论

在内克梅特镇的公共卫生设施中,结核病患者的治疗中断发生率较高。卫生设施应为合并症患者提供支持性护理,并考虑针对农村地区中年患者的干预措施,以减少治疗中断。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/75d7/10910942/08b65809677d/fepid-03-1234865-g001.jpg

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