Oyedele Opeoluwa, Shikongo Paulina Mweshitya
Department of Computing, Mathematical and Statistical Sciences, School of Science, University of Namibia, Windhoek, Namibia.
Department of Environmental Health, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa.
J Public Health Res. 2025 May 11;14(2):22799036251336969. doi: 10.1177/22799036251336969. eCollection 2025 Apr.
Multidrug-Resistant Tuberculosis (MDR-TB) is fast becoming a major public health concern, with 80% of the reported global MDR-TB deaths occurring in high burden countries including Namibia where drug susceptibility testing is not routinely performed. Previous studies on TB in Namibia have primarily focused on TB and HIV co-infection and MDR-TB development. However, no study to date has specifically examined the epidemiology of MDR-TB mortality or its associated risk factors at a national level. Thus, this study aimed at examining the variation of mortality among MDR-TB patients in Namibia and identifying its risk factors.
The study adopted a retrospective cohort study design using the 2014-2017 MDR-TB records, and a Gompertz PH model with Gamma (shared) frailty for the frailty modelling of the MDR-TB mortality and its associated risk factors.
There were more MDR-TB deaths among females, HIV positive patients with pulmonary TB in the Khomas region. MDR-TB mortality was more likely to occur for patients who were aged 55 and above (HR = 3.57, < 0.001, 95% CI: 2.18-5.91), HIV positive (HR = 2.07, < 0.001, 95% CI: 1.39-3.08), and from the Khomas (HR = 3.68, = 0.001, 95% CI: 1.72-7.87), Kunene (HR = 4.45, = 0.022, 95% CI: 1.24-15.91), Omusati (HR = 2.70, = 0.022, 95% CI: 1.15-6.31), and Oshana (HR = 2.51, = 0.021, 95% CI: 1.15-5.48) regions.
It is therefore recommended that the Namibian government and policy makers consider conducting outreach sessions to increase awareness on MDR-TB including early detection and screening programmes, and patient's adherence, especially among female patients aged 55 and above, with HIV and those living in these highlighted regions.
耐多药结核病（MDR-TB）正迅速成为一个主要的公共卫生问题，全球报告的耐多药结核病死亡病例中有80%发生在包括纳米比亚在内的高负担国家，在这些国家，药物敏感性检测并非常规开展。此前关于纳米比亚结核病的研究主要集中在结核病与艾滋病病毒合并感染以及耐多药结核病的发展情况。然而，迄今为止，尚无研究在国家层面专门考察耐多药结核病死亡率的流行病学情况或其相关危险因素。因此，本研究旨在考察纳米比亚耐多药结核病患者的死亡率差异并确定其危险因素。
本研究采用回顾性队列研究设计，使用2014 - 2017年耐多药结核病记录，并采用带有伽马（共享）脆弱性的Gompertz比例风险模型对耐多药结核病死亡率及其相关危险因素进行脆弱性建模。
在霍马斯地区，女性、患有肺结核的艾滋病病毒阳性患者中耐多药结核病死亡病例更多。55岁及以上患者（风险比[HR]=3.57，P<0.001，95%置信区间[CI]：2.18 - 5.91）、艾滋病病毒阳性患者（HR = 2.07，P<0.001，95% CI：1.39 - 3.08）以及来自霍马斯（HR = 3.68，P = 0.001，95% CI：1.72 - 7.87）、库内内（HR = 4.45，P = 0.022，95% CI：1.24 - 15.91）、奥穆萨蒂（HR = 2.70，P = 0.022，95% CI：1.15 - 6.31）和奥沙纳（HR = 2.51，P = 0.021，95% CI：1.15 - 5.48）地区的患者发生耐多药结核病死亡的可能性更高。
因此，建议纳米比亚政府和政策制定者考虑开展宣传活动，以提高对耐多药结核病的认识，包括早期检测和筛查计划以及患者的依从性，特别是在55岁及以上的女性患者、艾滋病病毒感染者以及生活在这些重点地区的人群中。
