Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study

Abstract

Background: Loss to follow-up (LTFU) from tuberculosis (TB) treatment and care is a major public health problem as patients can be infectious and also may develop a multi-drug resistant TB (MDR-TB). The study aimed to assess whether LTFU differs by the distance TB patients travelled to receive care from the nearest health facility.

Methods: A total of 402 patient cards of TB patients who received care were reviewed from March 1-30, 2020. The Kaplan-Meir curve with the Log-rank test was used to compare differences in LTFU by the distance travelled to reach to the nearest health facility for TB care. The Cox proportional hazard regression model was used to identify predictors. All statistical tests are declared significant at a p-value< 0.05.

Results: A total of 37 patients were LTFU with the incidence rate of 11.26 per 1000 person-months of observations (PMOs) (95% CI: 8.15-15.53). The incidence rate ratio was 12.19 (95% CI: 5.01-35.73) among the groups compared (those who travelled 10 km or more versus those who travelled less than 10 km). Age ≥ 45 years (aHR = 7.71, 95% CI: 1.72, 34.50), educational status (primary schooling, aHR = 3.54, 95% CI: 1.49, 8.40; secondary schooling, aHR = 2.75, 95% CI: 1.08, 7.03), lack of family support (aHR = 2.80, 95% CI: 1.27, 6.19), nutritional support (aHR = 3.40, 95% CI:1.68, 6.89), ≥ 10 km distance to travel to a health facility (aHR = 6.06, 95% CI: 2.33, 15.81) had significantly predicted LTFU from TB treatment and care.

Conclusions: LTFU from adult TB care and treatment was 12 times higher among those who travelled ≥10 km to reach a health facility compared to those who travelled less. To retain adult TB patients in care and ensure appropriate treatment, health professionals and other stakeholders should give due attention to the factors that drive LTFU. We suggest identifying concerns of older patients at admission and those who travel long distance and establish social support platforms that could help people to complete TB treatment.

Keywords: Adults; Distance to health facility; Loss to follow-up; Southern Ethiopia; Tuberculosis.

Fig. 1

Flow chart depicting how tuberculosis patients’ records from each facility are selected. Based on the number of TB patients enrolled during the study period, June 2016 to June 2019, the sample size was allocated proportionally to the studied health facilities (one primary hospital and three health centers). The distance patients had to travel to a health facility to receive care was the primary exposure variable to the outcome variable, loss to follow-up. TB = Tuberculosis

Fig. 2

Kaplan-Meier survival estimate of LTFU among adult TB patients on treatment in Gibe Woreda public health facility, Hadiya zone, Southern Ethiopia, from 2016 to 2019

Fig. 3

Survival experience of LTFU among adult TB patients on treatment by exposure status, in Gibe Woreda public health facility, Hadiya zone, Southern Ethiopia, from 2016 to 2019