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Determinants of Treatment Outcome Among Tuberculosis Patient in Jeju Woreda, Arsi Zone Oromia Regional State Ethiopia 2019

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Determinants of Treatment Outcome Among Tuberculosis Patient in Jeju Woreda, Arsi Zone Oromia Regional State Ethiopia 2019 Research Article International Journal of Public Health and Safety Volume 5:5,2020 Open Access Determinants of Treatment Outcome among Tuberculosis patient in Jeju Woreda, Arsi Zone Oromia Regional State Ethiopia 2019 Demissu Afferu*, Teresa Kisi, and Yealemwork Kerie College of Health Sciences, Department of Public Health, Arsi University, Ethiopia Abstract Introduction: Successful Tuberculosis treatment out comes are the most important to control tuberculosis. Due to poor treatment out comes new strain of tuberculosis are raising and it is a serious public health concern. It is compelling to identify, and deal with factors determining treatment outcome. Objectives: To identify Determinants of treatment outcome among Tuberculosis patients in Jeju woreda, Arsi zone Oromia Regional State Ethiopia 2019. Methods: A case control study was used where cases were unsuccessfully treated and controls were successfully treated patients. Data was collected by stratified random sampling method and prepared checklist from patients taking DOT in four health centers from June 28/2009 to June 27/ 2018 in Arsi Jeju woreda. The study was done from September 4-14/2019 on 509 controls and 127 cases, 636 total samples. The sample size was calculated by Epinfo version-7 with CI 95%, power 80% and 1:4 cases to control ratio. The samples were selected from TB registration book. Bivariate and multivariate logistic regression analyses were used with 95% confidence interval. Variables with p value <0.2 in Bivariate analyses were moved to multivariate logistic regression. Variable with P value <0.05 in multivariate analyses had significance association with TB treatment out comes. Results: The case group was composed of 93 (73% response rate) patients with poor treatment outcome while the control group was composed of 509 (100% response rate) patients with good treatment outcome. Un corrected drug dose during second phase treatment (AOR=17.949 95% CI 3.528-91.326), decrease weight at continuation phase (AOR=10.681 95% CI 3.076-37.098), positive sputum result at second month and HIV co-infection were the most determinant factors for unsuccessful treatment out comes of TB patients. Conclusion and Recommendations: Patients with weight loss, positive smear result at second month, un corrected drug dose at second phase of treatment and HIV positive patients were at higher risk for poor treatment out comes. While patient with increased weight, negative smear result at the end of second month, corrected drug dose at second phase of treatment and HIV negative TB patient were greater chance for good treatment out comes. Evaluation of weight and smear result at second phase of treatment and taking action for patient do not increase weight and unable to convert their smear result and HIV co-infected patients needs close follow up and corrective action would be taken for at risk patients. Corrected drug dose should be given at second phase of treatment. Keywords: Tuberculosis • Healthcare • Treatment • Patient • Resilience of infections remain asymptomatic [2]. TB can cause infection in persons with Introduction impaired immunity [3]. Many infections do not have symptoms, known as latent TB; where in about 10% of these latent infections can develop disease in Tuberculosis (TB) is an airborne infectious disease caused by rod-shaped lifetime which can kill about half of those infected [4]. The symptoms of active acid-fast bacillus Mycobacterium tuberculosis (MTB). It typically affects the pulmonary TB disease are coughing, with sputum or blood, chest pains, fever, lungs (pulmonary TB) but can affect other parts of the body as well (extra weight loss and night sweats. pulmonary TB). TB is transmitted through droplets from an infected person with active pulmonary disease released in the air through cough, sneeze or talking Worldwide, TB is one of the top 10 causes of death and the second leading and then inhaled by another person [1]. cause from a single infectious agent next to HIV/AIDS. In 2017, TB caused an estimated 1.3 million and 300 000 deaths among HIV-negative and positive Most infections with the bacteria do not cause TB disease and 90-95% people. Globally, the best estimate is that 10.0 million people developed TB disease in 2017: 5.8 million men, 3.2 million women and 1.0 million children. *Address for Correspondence: Demissu Afferu, BSC Nursing, College of Health There are cases in all countries and age groups, but overall 90% are adults Sciences, Department of Public Health, Arsi University, Ethiopia, Tel +0912306675; (aged ≥15 years), 9% are people living with HIV (72% in Africa) [5]. E-mail: [email protected] According to hospital statistics data, TB is the leading cause of morbidity, Copyright: © 2020 Afferu D, et al. This is an open-access article distributed under the third cause of hospital admission and the second cause of death in the terms of the Creative Commons Attribution License, which permits unrestricted Ethiopia(6). Ethiopia is one of the countries that are highly affected by TB use, distribution, and reproduction in any medium, provided the original author and source are credited. epidemics and ranked 7th among the 22 high TB burden countries in the world and third in Africa [6,7]. Received 30 September, 2020; Accepted 09 November, 2020; Published 16 November, 2020 Treatment outcome is the end health status of TB patient after taking anti Afferu D, et al. Int J Pub Health Safe, Volume 5: 5, 2020 TB treatment. It can be successful treatment outcome (cured+completed) or In china the study done in 2018 shows the treatment success rate was unsuccessful (died, defaulter, failure). The goal of TB treatment is not only to 92.2% among pulmonary TB case respectively [19]. cure the disease, but also to prevent its transmission and the development of Another study in Asian country including Turkeys, Korea and Pakistan drug resistance TB which is achieved by DOT of short course chemotherapy shows treatment success rate was 92.6%, 83.9% and 67.8% respectively [20-22]. regime [8]. In Somalia the study used a sample of 385 from 2013-2016 TB patients Tuberculosis (TB) is curable when adequate anti tubercular treatment there were 315 (81.8%) successful TB-TOs. Of successfully treated cases, (ATT) is properly administered. Since direct observation treatment (DOT) 33.9% are cured and the remaining completed cases. Besides, among patients strategy have been initiated by WHO favourable treatment outcomes are with unsuccessful treatment outcome, nearly 50% were died and the rest were achieved in about 85% of sputum smear-positive patients receiving standard treatment failures and defaulters [23]. short-course chemotherapy [9]. Study conducted in 2016 in South Africa Among 495 patients with treatment WHO recommend 85% of cure rate and 90% treatment success rate for outcomes reported, 80% (n=394) had successful outcomes, 11% (n=55) were well performing TB programs, which is adequate in reducing TB transmission, lost to follow-up, 8% (n=40) died and 1% (n=6) failed treatment [24]. morbidity and mortality. To achieve the required treatment outcomes WHO introduce DOT [10]. In Ethiopia the overall pooled TB treatment success rate from 2005-2017 is 86%. TB treatment success rate for each region showed that, Addis Ababa Statement of the problem and Justification of the study (93%), Oromia (84%), Amhara (86%), Southern Nations (83%), Tigray (85%) and Afar (86%) [13]. Statement of the problem: WHO set strategy for every country to reach treatment success rate ≥ 90% by 2025 [11]. However, globally treatment In Metema Hospital study conducted from 2009-2012 in 2015 shows from success rate was only 83% and 82% in 2015 and 2016 which shows poor a total of 2970 patients 2657 (89%) were new 167(5.7%) retreatment and 146 improvement [5,12]. The overall pooled TB treatment success rate from 2005- (4.9%) are transfer cases. With respect to the treatment outcomes, 65.3% 2017 was 86% in Ethiopia which was below the WHO treatment success rate were successfully treated, 88 (3.0%) died, 107 (3.3%) defaulted, 22 (0.7%) recommendation [13]. TSR increase from 84% (2015) to 90% (2016) in our failed and 814 (27.4%) were transferred out [25]. country [5,12]. The study done in South Omo Jinka General Hospital from 2004-2014 among 2156 patients result showed that 13.1% of the cases were cured, TB can be resistance to the drug used for treatment, when this occurs, 60.9% treatment completed, 10.2% died, 9.1% were lost to follow-up and 74% treatment is still possible, but it is complex, long, challenging and expensive. the overall treatment success [26]. Globally, it is estimated that nearly one in 25 new TB case and one in five previously treated cases of multidrug resistance TB (MDR TB) [7]. Four year retrospective study done by Wollega University in Neqemte General hospital among 315 TB patients registered from 2012-2016 show Different study result in Asia and Africa shows poor/unsuccessful treatment that 54(17.01%) are cured, 206(65.4%) completed treatment, 24(3.5%) out comes; mainly treatment failure and relapse are significantly associated had treatment failure, 11(3.5%) defaulted, 20(6.3%) were died. The overall with the rise of MDR TB [14-16]. treatment success rate of the TB patients was 82.5% [27]. Generally, unsuccessful TB treatment outcome, incomplete and in The study conducted in Debre Tabour general hospital done from 2008- adequate treatment is the most important factors that makes difficult to control TB. 2016 show that the overall successful treatment outcome was 90.1% (672) (cured and treatment complete) and 9.9%(74) (death and failure) were Justification of the study: Major contributing factors for poor treatment unsuccessful treatment out come from total of 985 patients included in nine out comes were not clearly known in the study area.
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