Trends and outcomes of tuberculosis among cases on directly observed short course treatment (DOTS) at Tepi public health center Southwest Ethiopia

Abstract

Background: Determining the trends and treatment outcomes of TB in health facilities is very important to inform better management of the disease and control efforts. Nevertheless, data from the rural, urban and suburban settings of Ethiopia show variability and inconsistency. This study was designed to evaluate trends and treatment outcomes of tuberculosis patients at Tepi Health Center and to identify the predictors of unsuccessful treatment outcome.

Method: Retrospective review of TB cases registered in Tepi health center between June 2011 and May 2018 was conducted using data extracted from medical records of TB patients. Structured data extraction form was prepared and used to extract socio-demographic, clinical and outcome data of study cases. Case definition and the treatment outcome of patients were ascertained and reported in accordance with World Health Organization guideline. Binary logistic regression model was fit to identify predictors of unsuccessful outcome.

Results: A total of 1651 TB patients registered at Tepi Public Health Center in between June 2011 and May 2018, were included in the study. Of all 924 (56%) were males and 1053 (63.8%) cases were in between the age range of 15 and 35 years. HIV-status of 1019 TB cases were unknown and 189 (11.4%) of participants were HIV-positive. Four hundred fifty seven (27.7%) cases were diagnosed with extra pulmonary TB (EPTB) and 1194 (72.3%) were pulmonary TB patients out of which, 376 (73.6%) were smear-positive pulmonary TB (PTB+). Overall treatment success rate (TSR) of patients was 80.4% (1327/1651), while it was 84.8% (134/158), 80.2% (410/511), and 78.3% (148/189) among the transfer-in, PTB+, and HIV + cases, respectively. Higher numbers of successful treatment outcomes were recorded among new patients (82.7%) and EPTB cases (84.7%). The cure rate were 73.6% (376/511) and 18% (34/189) among patients with PTB+ and HIV+, respectively. Multiple logistic regression analysis indicated that residence sites (OR 0.763 (0.584, 0.996) and TB/HIV co-infection (OR 0.661 (0.444, 0.985), were significantly associated with the treatment outcome. Rural residence was 27.1% less likely to have successful treatment. There was significant heterogeneity in the odds of having successful treatment outcomes across years of initiating treatment.

Conclusion: Treatment success rate among study cases was lower than the WHO's target and further efforts like availability of TB clinics in nearby sites and reducing rate of HIV infection should be made to improve rate of successful treatment outcome.

Keywords: Ethiopia; Sheka zone; Tepi health center; Treatment outcomes; Unsuccessful outcome.

Fig. 1

Trend analysis of treatment success rate in the peripheral settings of Ethiopia.

Fig. 2

Trend analysis of treatment success with respect to HIV-status, residence and sex of TB cases of Tepi health Centre.