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Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia

Received: 12 August 2021    Accepted: 7 September 2021    Published: 26 September 2021
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Abstract

Multidrug Resistance Tuberculosis (MDR-TB) is a major global public health crisis that needs great emphasis. Ethiopia is one of the 30 high TB, TB/HIV and drug resistant TB (DR-TB) burden countries globally and stands third among African countries. Treatment outcomes of MDR-TB are one of the essential performance indicators in evaluating the national TB control program. Such assessments however are limited at the facility and program level in Ethiopia. This study reported treatment outcomes and outcome predictors from a cohort of MDR-TB patients who were on WHO's longer treatment regimen at ALERT Hospital in Addis Ababa, Ethiopia. A retrospective assessment of patients’ records was made and data were collected for the period 2011-to 2016 using structured checklist. Data were double entered to Red Cap and exported to SPSS v20 for analysis. Descriptive statistics was computed to get summary results, bivariate and multivariate analysis was used to identify factors which affect the dependent variables. Therefore a total of 363 (53.7% males and 46.3% females) MDR-TB patients were included in the study. The mean age of the study participants was 29.6 years with the standard deviation of 11.2 years; the mean BMI was 18.5 with standard deviation of 3.0; and 78 (21.5%) were HIV positive. The most prevalent side effects were gastric disturbance which includes epigastric pain/discomfort, indigestion, bloating and nausea/vomiting (46.25%). Electrolyte abnormality occurred in (39.53%) of the patents. Among all assessed patients, 147 (40.5%) were cured, 132 (36.4%) completed their treatment, treatment failure occurred in three patients (0.8%), 46 (12.7%) patients died and 35 (9.6%) patients were lost to their follow-up. Overall, treatment success of 279 (76.9%) was observed in this cohort. Female and employed patients who can generate regular income had favorable treatment outcome with (AOR: 2.5; 95%CI: 1.4, 4.2), (AOR: 2.4; 95%CI: 1.4, 4.0) respectively Patients with HIV were 50% lower to have a favorable treatment outcome than HIV negative patients with (AOR: 0.5; 95%CI: 0.3, 0.9). So, it has been concluded that treatment success rate was generally encouraging. However, significant numbers of patients were lost to follow up and died. Thus, targeted interventions towards addressing factors that affected treatment outcome in MDR-TB patient management should be made. Strengthened follow up should also be in place to reduce number of lost to follow up and deaths in MDR-TB patients.

Published in American Journal of Health Research (Volume 9, Issue 5)
DOI 10.11648/j.ajhr.20210905.19
Page(s) 204-212
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Multi Drug Resistant, Treatment Outcome, ALERT Hospital, Addis Ababa, Ethiopia

References
[1] World Health Organization. Global tuberculosis report 2020 [Internet]. Geneva: World Health Organization; 2020 [cited 2021 Sep 3]. Available from: https://apps.who.int/iris/handle/10665/336069.
[2] World Health Organization. Regional Office for Europe, Solomonia N, Dadu A, Ehsani S, Sereda Y, Shah S, et al. Compliance of drug-resistant tuberculosis treatment regimens with drug susceptibility testing results and its association with treatment outcomes in Georgia. Public Health Panor. 2019; 5 (4): 515–24.
[3] World Health Organization. Regional Office for Europe. Final report on implementation of the Tuberculosis Action Plan for the WHO European Region 2016–2020 [Internet]. Copenhagen: World Health Organization. Regional Office for Europe; 2020 [cited 2021 Sep 6]. Available from: https://apps.who.int/iris/handle/10665/337926.
[4] FDREMOH. GUIDELINES FOR MANAGEMENT OF TB, DR-TB AND LEPROSY IN ETHIOPIA. SIXTH EDITION. Addis Ababa; 2018. 217 p.
[5] Federal Democratic Republic of Ethiopia Ministry of Health. NATIONAL STRATEGIC PLAN TUBERCULOSIS AND LEPROSY CONTROL 2006–2013 EC (2013/14–2020). Addis Ababa Ethiopia; 2018. 88 p.
[6] Sotgiu G, Tiberi S, Centis R, D’Ambrosio L, Fuentes Z, Zumla A, et al. Applicability of the shorter ‘Bangladesh regimen’ in high multidrug-resistant tuberculosis settings. Int J Infect Dis. 2017 Mar; 56: 190–3.
[7] Meressa D, Hurtado RM, Andrews JR, Diro E, Abato K, Daniel T, et al. Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia—an observational cohort study. Thorax. 2015 Dec; 70 (12): 1181–8.
[8] Aibana O, Bachmaha M, Krasiuk V, Rybak N, Flanigan TP, Petrenko V, et al. Risk factors for poor multidrug-resistant tuberculosis treatment outcomes in Kyiv Oblast, Ukraine. BMC Infect Dis [Internet]. 2017 Dec [cited 2017 Aug 5]; 17 (1). Available from: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2230-2.
[9] Elliott E, Draper HR, Baitsiwe P, Claassens MM. Factors affecting treatment outcomes in drug-resistant tuberculosis cases in the Northern Cape, South Africa. Public Health Action. 2014 Sep 21; 4 (3): 201–3.
[10] Morris MD, Quezada L, Bhat P, Moser K, Smith J, Perez H, et al. Social, economic, and psychological impacts of MDR-TB treatment in Tijuana, Mexico: a patient’s perspective. Int J Tuberc Lung Dis. 2013 Jul 1; 17 (7): 954–60.
[11] Management Sciences for Health. Costs faced by multi-drug resistant tuberculosis patients during diagnosis and treatment. Report from a pilot study in Ethiopia. Management Sciences for Health; 2014 Jan p. 48.
[12] Farley JE, Ram M, Pan W, Waldman S, Cassell GH, Chaisson RE, et al. Outcomes of Multi-Drug Resistant Tuberculosis (MDR-TB) among a Cohort of South African Patients with High HIV Prevalence. Goletti D, editor. PLoS ONE. 2011 Jul 22; 6 (7): e20436.
[13] Phuong NTM, Nhung NV, Hoa NB, Thuy HT, Takarinda KC, Tayler-Smith K, et al. Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam. Public Health Action. 2016 Mar 21; 6 (1): 25–31.
[14] Tsegaye Tulu, Mesfin Haile Kahissay. Assessment of Multidrug Resistance Tuberclosis Treatment Outcome in St. Petre’s Tuberclosis Specialized Hospital, Addis Ababa, Ethiopia. Malays J Med Biol Res. 2014 Dec 30; 1, No 3 (2014): 97–107.
[15] Biruk M, Yimam B, Abrha H, Biruk S, Amdie FZ. Treatment Outcomes of Tuberculosis and Associated Factors in an Ethiopian University Hospital. Adv Public Health. 2016; 2016: 1–9.
[16] Milanov V, Falzon D, Zamfirova M, Varleva T, Bachiyska E, Koleva A, et al. Factors associated with treatment success and death in cases with multidrug-resistant tuberculosis in Bulgaria, 2009–2010. Int J Mycobacteriology. 2015 Jun; 4 (2): 131–7.
[17] Marina Kikvidze, Lali Ikiashvili. Comorbidities and MDR-TB treatment outcomes in Georgia- 2009-11 cohort. Eur Respir J. 2014.
[18] Tang S, Tan S, Yao L, Li F, Li L, Guo X, et al. Risk Factors for Poor Treatment Outcomes in Patients with MDR-TB and XDR-TB in China: Retrospective Multi-Center Investigation. Wilkinson KA, editor. PLoS ONE. 2013 Dec 5; 8 (12): e82943.
[19] Huang F-L, Jin J-L, Chen S, Zhou Z, Diao N, Huang H-Q, et al. MTBDRplus results correlate with treatment outcome in previously treated tuberculosis patients. Int J Tuberc Lung Dis. 2015 Mar 1; 19 (3): 319–25.
[20] Helbling P, Altpeter E, Egger J, Zellweger J. Treatment outcomes of multidrug-resistant tuberculosis in Switzerland. Swiss Med Wkly [Internet]. 2014 Dec 4 [cited 2017 Aug 5]; Available from: http://doi.emh.ch/smw.2014.14053.
[21] European Centre for Disease Prevention and Control. Rapid Risk Assessment: Healthcare system factors influencing treatment results of MDR TB patients. Stockholm: European Centre for Disease Prevention and Control, 2014 p. 6.
[22] Bassili A, Qadeer E, Floyd K, Fitzpatrick C, Fatima R, Jaramillo E. A Systematic Review of the Effectiveness of Hospital- and Ambulatory-Based Management of Multidrug-Resistant Tuberculosis. Am J Trop Med Hyg. 2013 Aug 7; 89 (2): 271–80.
[23] International Union Against, Tuberculosis and Lung Disease (The Union). 46th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease. In: The Official Journal of the International Union Against Tuberculosis and Lung Disease. CAPE TOWN, SOUTH AFRICA: The International Journal of Tuberculosis and Lung Disease; 2015. p. S S 1–S 588.
[24] Waheed Z, Irfan M, Haque AS, Khan MO, Zubairi A, ul Ain N, et al. Treatment Outcome of Multi-Drug Resistant Tuberculosis Treated As Outpatient in a Tertiary Care Center. Pak J Chest Med [Internet]. 2011 [cited 2017 Aug 6]; 17 (3). Available from: http://pjcm.net/index.php/pjcm/article/view/121.
[25] Kibret KT, Moges Y, Memiah P, Biadgilign S. Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies. Infect Dis Poverty [Internet]. 2017 Dec [cited 2017 Aug 5]; 6 (1). Available from: http://idpjournal.biomedcentral.com/articles/10.1186/s40249-016-0214-x.
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    Netsanet Aragaw, Mekonnen Teferi, Oumer Ali, Emawayish Tesema, Samuel Ayele, et al. (2021). Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia. American Journal of Health Research, 9(5), 204-212. https://doi.org/10.11648/j.ajhr.20210905.19

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    ACS Style

    Netsanet Aragaw; Mekonnen Teferi; Oumer Ali; Emawayish Tesema; Samuel Ayele, et al. Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia. Am. J. Health Res. 2021, 9(5), 204-212. doi: 10.11648/j.ajhr.20210905.19

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    AMA Style

    Netsanet Aragaw, Mekonnen Teferi, Oumer Ali, Emawayish Tesema, Samuel Ayele, et al. Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia. Am J Health Res. 2021;9(5):204-212. doi: 10.11648/j.ajhr.20210905.19

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  • @article{10.11648/j.ajhr.20210905.19,
      author = {Netsanet Aragaw and Mekonnen Teferi and Oumer Ali and Emawayish Tesema and Samuel Ayele and Habtamu Jarso and Kifle Woldemichael},
      title = {Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia},
      journal = {American Journal of Health Research},
      volume = {9},
      number = {5},
      pages = {204-212},
      doi = {10.11648/j.ajhr.20210905.19},
      url = {https://doi.org/10.11648/j.ajhr.20210905.19},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20210905.19},
      abstract = {Multidrug Resistance Tuberculosis (MDR-TB) is a major global public health crisis that needs great emphasis. Ethiopia is one of the 30 high TB, TB/HIV and drug resistant TB (DR-TB) burden countries globally and stands third among African countries. Treatment outcomes of MDR-TB are one of the essential performance indicators in evaluating the national TB control program. Such assessments however are limited at the facility and program level in Ethiopia. This study reported treatment outcomes and outcome predictors from a cohort of MDR-TB patients who were on WHO's longer treatment regimen at ALERT Hospital in Addis Ababa, Ethiopia. A retrospective assessment of patients’ records was made and data were collected for the period 2011-to 2016 using structured checklist. Data were double entered to Red Cap and exported to SPSS v20 for analysis. Descriptive statistics was computed to get summary results, bivariate and multivariate analysis was used to identify factors which affect the dependent variables. Therefore a total of 363 (53.7% males and 46.3% females) MDR-TB patients were included in the study. The mean age of the study participants was 29.6 years with the standard deviation of 11.2 years; the mean BMI was 18.5 with standard deviation of 3.0; and 78 (21.5%) were HIV positive. The most prevalent side effects were gastric disturbance which includes epigastric pain/discomfort, indigestion, bloating and nausea/vomiting (46.25%). Electrolyte abnormality occurred in (39.53%) of the patents. Among all assessed patients, 147 (40.5%) were cured, 132 (36.4%) completed their treatment, treatment failure occurred in three patients (0.8%), 46 (12.7%) patients died and 35 (9.6%) patients were lost to their follow-up. Overall, treatment success of 279 (76.9%) was observed in this cohort. Female and employed patients who can generate regular income had favorable treatment outcome with (AOR: 2.5; 95%CI: 1.4, 4.2), (AOR: 2.4; 95%CI: 1.4, 4.0) respectively Patients with HIV were 50% lower to have a favorable treatment outcome than HIV negative patients with (AOR: 0.5; 95%CI: 0.3, 0.9). So, it has been concluded that treatment success rate was generally encouraging. However, significant numbers of patients were lost to follow up and died. Thus, targeted interventions towards addressing factors that affected treatment outcome in MDR-TB patient management should be made. Strengthened follow up should also be in place to reduce number of lost to follow up and deaths in MDR-TB patients.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Treatment Outcomes and Predictors of Outcome in Multidrug Resistance Tuberculosis (MDR-TB) Cohort of Patients in Addis Ababa, Ethiopia
    AU  - Netsanet Aragaw
    AU  - Mekonnen Teferi
    AU  - Oumer Ali
    AU  - Emawayish Tesema
    AU  - Samuel Ayele
    AU  - Habtamu Jarso
    AU  - Kifle Woldemichael
    Y1  - 2021/09/26
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajhr.20210905.19
    DO  - 10.11648/j.ajhr.20210905.19
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 204
    EP  - 212
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20210905.19
    AB  - Multidrug Resistance Tuberculosis (MDR-TB) is a major global public health crisis that needs great emphasis. Ethiopia is one of the 30 high TB, TB/HIV and drug resistant TB (DR-TB) burden countries globally and stands third among African countries. Treatment outcomes of MDR-TB are one of the essential performance indicators in evaluating the national TB control program. Such assessments however are limited at the facility and program level in Ethiopia. This study reported treatment outcomes and outcome predictors from a cohort of MDR-TB patients who were on WHO's longer treatment regimen at ALERT Hospital in Addis Ababa, Ethiopia. A retrospective assessment of patients’ records was made and data were collected for the period 2011-to 2016 using structured checklist. Data were double entered to Red Cap and exported to SPSS v20 for analysis. Descriptive statistics was computed to get summary results, bivariate and multivariate analysis was used to identify factors which affect the dependent variables. Therefore a total of 363 (53.7% males and 46.3% females) MDR-TB patients were included in the study. The mean age of the study participants was 29.6 years with the standard deviation of 11.2 years; the mean BMI was 18.5 with standard deviation of 3.0; and 78 (21.5%) were HIV positive. The most prevalent side effects were gastric disturbance which includes epigastric pain/discomfort, indigestion, bloating and nausea/vomiting (46.25%). Electrolyte abnormality occurred in (39.53%) of the patents. Among all assessed patients, 147 (40.5%) were cured, 132 (36.4%) completed their treatment, treatment failure occurred in three patients (0.8%), 46 (12.7%) patients died and 35 (9.6%) patients were lost to their follow-up. Overall, treatment success of 279 (76.9%) was observed in this cohort. Female and employed patients who can generate regular income had favorable treatment outcome with (AOR: 2.5; 95%CI: 1.4, 4.2), (AOR: 2.4; 95%CI: 1.4, 4.0) respectively Patients with HIV were 50% lower to have a favorable treatment outcome than HIV negative patients with (AOR: 0.5; 95%CI: 0.3, 0.9). So, it has been concluded that treatment success rate was generally encouraging. However, significant numbers of patients were lost to follow up and died. Thus, targeted interventions towards addressing factors that affected treatment outcome in MDR-TB patient management should be made. Strengthened follow up should also be in place to reduce number of lost to follow up and deaths in MDR-TB patients.
    VL  - 9
    IS  - 5
    ER  - 

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Author Information
  • Armauer Hansen Research Institute, Addis Ababa, Ethiopia

  • Armauer Hansen Research Institute, Addis Ababa, Ethiopia

  • Armauer Hansen Research Institute, Addis Ababa, Ethiopia

  • All Africa Leprosy, Tuberculosis and Rehabilitation Training Centre, Addis Ababa, Ethiopia

  • Armauer Hansen Research Institute, Addis Ababa, Ethiopia

  • Department of Epidemiology, College of Health Science, Jimma University, Jimma, Ethiopia

  • Department of Epidemiology, College of Health Science, Jimma University, Jimma, Ethiopia

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