Baseline socio-demographic characteristics
A total of 465 patients were included in the final analysis. Most of the patients (61.1%) had follow ups at the University of Gondar comprehensive specialized hospital, followed by Borumeda (28.2%) and the rest at Debremarkos.
More than half (58%) of the patients were male with the median age at initiation of treatment of 28(IQR, 22 to 38 years), and 60.8% of them were aged between 15 and 34 years. Of the participants, 43.2% and 34.4% were married and single, respectively; 58% had some primary and above educational status, while rural dwellers constituted 52% of the respondents. As far as substance use was concerned, 18.9%, 12.9%, and 8.6% drunk alcohol, smoked cigarettes, and chewed khat, respectively (Table 1).
Clinical characteristics
The pulmonary form of MDRTB accounted for 92.5% while the rest were extra pulmonary forms. One-fourth (25.4%) of the MDRTB patients 94% of whom were on ART had HIV co-infections. One or more medical co-morbidities reported, involved 9.2% of the participants of whom 2.58% had diabetes mellitus. One or more radiological abnormalities were seen in 72% of the patients. The most common radiological findings included 42.2% cavitation, 28.6% infiltration, and 24.5% chronic changes, like fibrosis. Out of the total patients, 72% had one and above adverse drug reactions with gastro-intestinal upset, (81.5%) and electrolyte disturbance (33.6%), the most common side effects (Table 2).
Tuberculosis diagnosis and treatment characteristics
Most patients (89.5%) had one or more previous TB treatment history, one patient for a maximum of seven times. Line probe assay (LPA) (45.6%) and Gene Xpert (46.7%) were the most commonly used diagnostic methods for confirmation of drug resistance TB. In relation to TB resistance pattern, 96.3% of the patients had confirmatory drug resistance test results, 96% resistant to Rifampicin and 45.6% to Isoniazid. In addition, 8.3% of the patients were resistant to all first line anti-TB drugs. Seventy percent of the patients were initiated second line anti-TB treatment within 30 days of diagnosis. The median follow up time for the intensive phase was 8.4 (IQR, 7.97 to 8.93 months). The time to sputum culture conversion among pulmonary TB victims was a median of 2 (IQR, 1 to 3 months) (Table 3).
Length of in-hospital stay (LOS)
The median length of hospital stay during the intensive phase of MDRTB treatment was 61 (IQR, 34 to101 days) with the mean (SD) of 78.3 (±66.6) days. The median length of hospital stay for each treatment center at the University of Gondar hospital was 59.5 (IQR, 34 to 100 days), Borumeda 72 (IQR, 47 to 111 days), and Debremarkos referral hospital 39.5 (IQR, 24 to76 days). Two hundred thirty-six (50.7%) patients with a 95%CI (46.1 to 55.3) were hospitalized for longer than 61 days during the intensive the phase of the MDRTB treatment. Only 37 (7.9%) stayed hospitalized for over 6 months. The median length of hospital stay overtime is shown in (Fig. 1).
Predictors of longer in-hospital stay
In the bi-variable binary logistic regression, age, housing condition, occupation, pulmonary form of multidrug resistant tuberculosis, adverse drug effects, registration group, functional status at admission, and treatment initiating centers (hospitals) were significant at a P-value of 0.2.
In the multivariable regression analysis, functional status at admission, adverse drug reactions, pulmonary form of TB, and treatment initiating centers (hospitals) were significantly associated with longer hospital stay at a P value of 0.05. Patients who had Functional status of ambulatory (AOR=2.25, 95%CI: 1.19 - 4.27) and bedridden (AOR=3.39, 95%CI: 1.57 7.35) functional status at admission had longer hospital stay compared to those who had working functional status. Patents who had pulmonary form of MDRTB were associated with longer hospital stay compared to extra pulmonary cases (AOR=3.20, 95%CI: 1.28 7.96). Similarly, treatment initiating centers the University of Gondar (AOR=2.11, 95%CI: 1.02 4.41) and Borumeda (AOR=3.59, 95%CI: 1.67, 7.71) showed significant differences in LOS compared to Debremarkos. Patients who had reports of adverse drug reaction were more likely to have longer hospital stays compared to those who didn’t have such reaction (AOR=2.54, 95%CI: 1.60, 4.02) (Table 4).