Abstract
Directly Observed Treatment Short-course (DOTS) has been one of the major strategies to combat the epidemic of tuberculosis (TB) globally. This study aimed to evaluate TB treatment outcomes between September 2004 and July 2014 under the DOTS program at one of the largest public hospitals in Ethiopia. A retrospective data of TB patients registered at Asella Teaching Hospital between September 2004 and July 2014 were obtained from hospital registry. Treatment outcomes and types of TB cases were categorized according to the national TB control program guideline. Binomial and multinomial logistic regression models were used to analyze the association between treatment outcomes and potential predictor variables. A total of 1,755 TB patients' records were included in the study. Of these, 945 (53.8%) were male, 480 (27.4%) smear-positive TB, 287 (16.4%) HIV positive, and 1,549 (88.3%) new cases. Among 480 smear-positive pulmonary TB cases, 377 (78.5%) patients were cured, 21 (4.40) completed the treatment, 35 (7.3%) transferred out, 19 (4.0%) died, 24 (5.0%) defaulted, and 4 (0.8%) failure. Overall, 398 (82.9%) smear-positive pulmonary TB patients were successfully treated. For smear-negative TB (n = 641) and extrapulmonary TB cases (n = 634), 1,036 (81.3%) completed the treatment and demonstrated favorable response. Taking all TB types into account, 1,434 (81.7%) were considered as successfully treated. In the multivariate binary logistic model, patients in older age group (AOR = 0.386, 95% CI: 0.250-0.596) and retreatment cases (AOR = 0.422, 95% CI: 0.226-0.790) were less likely to be successfully treated compared to younger and new cases, respectively. In multinomial logistic regression, age increment by 1 year increased the risk of death and default of TB patients by 0.05 (adjusted β = 0.05; 95% CI: 0.03, 0.06) and 0.02 (adjusted β = 0.02; 95% CI: 0.01, 0.04). The odds of TB patients who died during treatment were higher among HIV-infected TB patients (adjusted β = 2.65; 95% CI: 1.28, 5.50). The treatment success rate of TB patients was low as compared to the national target. TB control needs to be strengthened for the enhancement of treatment outcome.
Highlights
Tuberculosis (TB) remains a major global health problem and has replaced HIV as the leading cause of death from a single infectious agent in 2016 [1]
We aimed to evaluate the treatment outcomes of TB between September 2004 and July 2014 under Directly Observed Treatment Short-course (DOTS) program at Asella Teaching Hospital (ATH) in Ethiopia, East African country with TB incidence of 191/100,000 population [2]
Recommendations on how to evaluate treatment outcomes using standardized categories have been issued by the World Health Organization (WHO) in conjunction with the European Region of the International Union Against TB and Lung Disease [14]
Summary
Tuberculosis (TB) remains a major global health problem and has replaced HIV as the leading cause of death from a single infectious agent in 2016 [1]. Study on the natural history of TB indicated that up to 70% of smear-positive and 20% of smear-negative cases of pulmonary TB died within 10 years if patients remain untreated [5]. Cognizant of this fact, World Health Organization (WHO) introduced Directly Observed Treatment Short-course (DOTS) strategy in the early 1990s, with the target to cure 85% of newly detected cases of sputum smear-positive TB and to detect 70% of the estimated incidence of sputum smear-positive TB [6, 7]. This study aimed to evaluate TB treatment outcomes between September 2004 and July 2014 under the DOTS program at one of the largest public hospitals in Ethiopia
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