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Observational Study
. 2019 Dec 30;19(1):1087.
doi: 10.1186/s12879-019-4709-5.

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

Simon Mutembo  1   2 , Jane N Mutanga  3   4 , Kebby Musokotwane  4 , Cuthbert Kanene  5 , Kevin Dobbin  3 , Xiaobai Yao  3 , Changwei Li  3 , Vincent C Marconi  6 , Christopher C Whalen  3
Affiliations
Observational Study

Urban-rural disparities in treatment outcomes among recurrent TB cases in Southern Province, Zambia

Simon Mutembo et al. BMC Infect Dis. .

Abstract

Background: At least 13-20% of all Tuberculosis (TB) cases are recurrent TB. Recurrent TB has critical public health importance because recurrent TB patients have high risk of Multi-Drug Resistant TB (MDR-TB). It is critical to understand variations in the prevalence and treatment outcomes of recurrent TB between different geographical settings. The objective of our study was to estimate the prevalence of recurrent TB among TB cases and compare risk of unfavorable treatment outcomes between rural and urban settings.

Methods: In a retrospective cohort study conducted in southern province of Zambia, we used mixed effects logistic regression to asses associations between explanatory and outcome variables. Primary outcome was all-cause mortality and exposure was setting (rural/urban). Data was abstracted from the facility TB registers.

Results: Overall 3566 recurrent TB cases were diagnosed among 25,533 TB patients. The prevalence of recurrent TB was 15.3% (95% CI: 14.8 15.9) in urban and 11.3% (95% CI: 10.7 12.0) in rural areas. Death occurred in 197 (5.5%), 103 (2.9%) were lost to follow-up, and 113 (3.2%) failed treatment. Rural settings had 70% higher risk of death (adjusted OR: 1.7; 95% CI: 1.2 2.7). Risk of lost to follow-up was twice higher in rural than urban (adjusted OR: 2.0 95% CI: 1.3 3.0). Compared to HIV-uninfected, HIV-infected individuals on Antiretroviral Treatment (ART) were 70% more likely to die (adjusted OR: 1.7; 95% CI: 1.2 3.1).

Conclusion: Recurrent TB prevalence was generally high in both urban and rural settings. The risk of mortality and lost to follow-up was higher among rural patients. We recommend a well-organized Directly Observed Therapy strategy adapted to setting where heightened TB control activities are focused on areas with poor treatment outcomes.

Keywords: Death; Recurrent tuberculosis; Rural; Treatment outcomes; Urban.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Consort diagram showing the selection of recurrent TB patients and treatment outcomes in rural and urban setting
See this image and copyright information in PMC

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