Profile and determinants of unsuccessful tuberculosis outcome in rural Nigeria: Implications for tuberculosis control.

Abstract

To determine the treatment outcomes and predictors for unsuccessful tuberculosis (TB) outcomes in rural Nigeria. Adult rural TB patients treated during 2011 and 2012 in two healthcare facilities (one urban public and one rural private) were identified from the TB treatment registers and retrospectively reviewed. Tuberculosis treatment outcomes were assessed according to World Health Organisation guidelines. Determinants of unsuccessful treatment outcomes were identified using a multivariable logistic regression analysis. Between January 2011 to December 2012, 1180 rural TB patients started treatment, of whom 494 (41.9%) were female. The treatment success rate was 893 (75.7%), while the rates of death, loss-to-follow-up, and treatment failure were 129 (10.9%), 100 (8.5%), and 18 (1.5%) respectively. In the final multivariable logistic regression model, the odds of unsuccessful treatment outcome were higher among patients who received care at the urban public facility (aOR = 2.9, 95%CI: 1.9-4.4), smear-negative (1.3, 1.0-1.8) and extrapulmonary (2.7, 1.3-5.6) TB patients, human immunodeficiency virus (HIV) co-infected (2.1, 1.5-3.0), and patient who received the longer (8-mo) anti-TB regimen (1.3, 1.1-1.8). Treatment success among rural TB patient in Nigeria is low. High risk groups should be targeted for closer monitoring, socio-economic support, and expansion of TB/HIV activities.