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Meta-Analysis
. 2021 Mar 18;16(3):e0248687.
doi: 10.1371/journal.pone.0248687. eCollection 2021.

Lost to follow-up and associated factors among patients with drug resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

Assefa Andargie  1 , Asressie Molla  1 , Fentaw Tadese  1 , Segenet Zewdie  2
Affiliations
Meta-Analysis

Lost to follow-up and associated factors among patients with drug resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

Assefa Andargie et al. PLoS One. .

Abstract

Background: One third of global antmicrobial resistance deaths are attributed to drug resistant tuberculosis. Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis. There is a gap in nationally representative reliable information on lost to follow-up among patients with drug-resistant tuberculosis in Ethiopia.

Objective: To estimate the pooled prevalence and associated factors of lost to follow-up among patients with drug resistant tuberculosis in Ethiopia.

Methods: Observational studies searched from PubMed, HINARI and CINAHL were screened for eligibility. After assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q and I2. The random effects meta-analysis model was employed to pull the prevalence of lost to follow-up. Sub-group analysis and meta regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's and Begg's tests. Sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The odds ratios were used to measure associations.

Results: The review was performed among 11 studies of which 9 were cohort studies. The sample sizes ranged from 90 to 612 and comprised a total of 3,510 participants. The pooled prevalence of lost to follow-up was 8.66% (95% CI, 5.01-13.14) with a high heterogeneity (I2 = 93.49%, p<0.001). Pulmonary multi-drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients.

Conclusion: There was a high prevalence of lost to follow-up among multi-drug resistant tuberculosis patients in Ethiopia. Anatomical site of tuberculosis was a significant factor affecting lost to follow-up. Strengthening the health care system and patient education should be given a due emphasis.

Registration number: CRD42020153326; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=153326.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of included studies in the systematic review and meta-analysis of lost to follow-up and associated factors among patients with MDR-TB in Ethiopia from 2014–2020.
Fig 2
Fig 2. Forest plot of the pooled prevalence of lost to follow-up among patients with MDR-TB in Ethiopia from 2014–2020.
Fig 3
Fig 3. Forest plot for the sub-group analysis of the prevalence of lost to follow-up among patients with MDR-TB by study region in Ethiopia from 2014–2020.
Fig 4
Fig 4. Forest plot for the sub-group analysis of the prevalence of lost to follow-up among patients with MDR-TB by publication (study) year in Ethiopia from 2014–2020.
Fig 5
Fig 5. Sensitivity analysis for single study influence on the prevalence of LTFU in Ethiopia from 2014–2020.
Fig 6
Fig 6. A funnel plot for publication bias of lost to follow-up among patients with MDR-TB in Ethiopia from 2014–2020.
Fig 7
Fig 7. Forest plot of the pooled effect of anatomical site of TB on lost to follow-up among patients with MDR-TB in Ethiopia from 2014–2020.
Fig 8
Fig 8. A funnel plot for publication bias of the effect of anatomical site of TB on lost to follow-up among patients with MDR-TB in Ethiopia from 2014–2020.
See this image and copyright information in PMC

References

    1. World Health Organization. Global Tuberculosis Report 2019. Geneva; 2019.
    1. The Global fund. Drug-resistant Tuberculosis. 2019. http://www.theglobalfund.org.
    1. Diriba G, Kebede A, Tola HH, Alemu A, Tadesse M, Tesfaye E. Surveillance of drug resistance tuberculosis based on reference laboratory data in Ethiopia. Infect Dis Poverty. 2019;8: 4–9. - PMC - PubMed
    1. Federal Ministry of Health of Ethiopia. Guideline for program and clinical management of drug resistant tuberculosis. 5th ed. Addis Ababa, Ethiopia: FMOH; 2009.
    1. Federal Ministry of Health. National Programmatic management of Drug resistant TB in Ethiopia: Participant’s manual. Addis Ababa: FMOH; 2019. pp. 46–58.

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