Predictors of poor tuberculosis treatment outcome at arba minch general hospital, southern Ethiopia: a casecontrol study

Abstract

Tuberculosis (TB) is the leading cause of death in the world. Ethiopia ranks seventh among the world's 22 countries with a high burden of TB. Currently, Ethiopia reports treatment success rate of 83%. Even where free medication is available, many patients are not successfully treated for TB. Therefore, this study is aimed at assessing predictors of poor TB treatment outcome at Arba Minch General Hospital (AMGH), Southern Ethiopia. Methods: A case- control study comprising simple random sampling was conducted at AMGH from January 30 to February 28, 2014. Cases were patients who were registered as failed treatment, defaulted or died during TB treatment and controls were patients who were registered as cured or completed treatment in the period 1 st January 2009- 30th December 2013 in AMGH. A prepared standard checklist which is adapted from WHO and according to the objectives of the study was used to assess the predictors of poor treatment outcome, a chi-square test and a T-test were used to compare categorical and continuous variables between the two groups, respectively. P- Value of less than 0.05 was considered statistically significant in the final model. Result: The case group was composed of 224 patients with poor outcome while the control group was composed of 448 patients with successful outcome. Male sex (AOR=1.600 (95%CI=1.104, 2.317), age older than 35 years (AOR=2.381 (95%CI=1.643, 3.448), rural residence (AOR=1.496 (95%CI=1.037, 2.159), retreatment category(AOR=3.305 (95%CI=1.298, 8.415), smear negative PTB (AOR=2.4 (CI=1.4,4.1), EPTB (AOR=2.5(CI=(1.3, 4.6)), positive smear at 2nd/3rdmonth (AOR=53.3 (95%CI= 9.6, 296.1),HIV positive (AOR=2.364 (95%CI=1.574, 3.552) and not tested for HIV(AOR=2.553 (95%CI=1.283, 5.081), treatment of TB in the year before 2011 G.C were predictors of poor TB treatment outcome. Conclusion: Male patients, those resided in rural area, older age, previously treated patients, patients with smear negative PTB and EPTB, having positive smear at 2nd/3rdmonth follow up, HIV co-infected patients, those not tested for HIV and treated for TB before 2011 G.C were at significantly increased risk of developing poor outcome. Targeted measures should be considered to reduce the rate of poor outcome among high-risk groups; careful monitoring, making DOTS program more accessible for the rural population, sputum smear examinations during follow up, counseling patients with TB on the need for HIV testing, linking the HIV positive patients to support groups, Drug susceptibility test (DST) is also highly recommended for all previously treated patients before they are treated with the retreatment regimen