Socio-demographic Characteristics of the Patients:
A total of 384 MDR-TB patient medical charts was reviewed and included in the study. The majority, 245(63.8%) of the study subjects were females and 139(36.2%) were males. More than three-forth, 306(79.7%) of the patients were in the age group of 39-60 years with a mean ± SD of 29.40 + 9.81yrs. The weight of most 202(52.6%) of the patients was in the range of 18-48Kg with a mean ± SD of 50.47±8.02Kg (table 1).
Table 1: Socio-demographic Characteristics of the Patients, St. Peter Specialized Hospital, Addis Ababa, Ethiopia, 2019
Variable
|
Category
|
Frequency
|
Percent
|
Sex
|
Male
|
139
|
36.2
|
Female
|
245
|
63.8
|
Age (Yrs)
|
18-38
|
78
|
20.3
|
39-60
|
306
|
79.7
|
Mean + SD
|
29.40+ 9.81
|
|
Body weight (Kg)
|
38-55
|
202
|
52.6
|
56-73
|
182
|
47.4
|
Mean ±SD
|
50.47±8.02
|
|
Clinical Characteristics of the Patients:
From a total of 384 patient medical charts reviewed, the majority 340(88.5%) had pulmonary TB and only a small proportion of 44(11.5%) of them have had an extrapulmonary TB. About three fourth 292(76.0%) of them were new cases and 92(23.0%) retreatment MDR-TB cases. It was found that 288(75.0%) of the patients were resistant to first-line drugs. Regarding the treatment duration, 110(28.6%) of the patients were treated for 6-18months with a mean ± SD of 14.52+5.13 months. More than half 230(59.9%) of them have HIV/AIDS (Table 2).
Table 2: Clinical Characteristics of the Patients, St. Peter Specialized Hospital, Addis Ababa, Ethiopia, 2019
Variable
|
Category
|
Frequency
|
Percent
|
Site of TB infection
|
Pulmonary TB
|
340
|
88.5
|
Extraplumonary TB
|
44
|
11.5
|
TB treatment history
|
Retreatment
|
292
|
76.0
|
New
|
92
|
23.0
|
TB treatment-resistant
|
First-line
|
288
|
75.0
|
Second-line
|
96
|
25.0
|
TB treatment Duration
|
6-18
|
110
|
28.6
|
19-30
|
276
|
71.4
|
Mean ±SD
|
14.52+5.13
|
|
Smear test
|
Positive
|
243
|
63.3
|
Negative
|
141
|
36.7
|
HIV Status
|
Yes
|
230
|
59.9
|
No
|
154
|
40.1
|
Treatment Outcome of MDR-TB:
The overall treatment outcome of MDR-TB was classified as a good (favorable) outcome if the patient is cured and a poor (unfavorable) outcome if the patient is default or died. From the total 384 MDR-TB patient medical charts reviewed, more than half 211(54.9 %) of them had good treatment outcomes. The rate of unfavorable treatment outcome was found to be high, 173(45.1%); from which 106(27.6%) have died of the disease, and 67(17.5%) have defaulted from the treatment (figure 1).
Factors associated with MDR-TB treatment outcome:
A bivariate and multivariate logistic regression model was carried out to determine the factors affecting the MDR-TB treatment outcome. Only variables with a p-value ≤ 0.2 were included in the multivariate regression. Hence, Age, sex, treatment resistance, duration of treatment, smear result, and HIV status were found to be significantly associated with MDR-TB treatment outcome.
Male patients and patients in the age group of 39-60 years were less likely to have poor outcome compared to female patients and patients in the age category of 18-38 years (AOR = 0.43, 95%CI (0.19, 0.10) and (AOR = 0.28, 95%CI (0.15, 0.52) respectively. Patients who have a history of second-line TB drug resistance are approximately four times to have poor treatment outcomes compared to patients who have a history of first-line TB drugs (AOR = 3.81, 95%CI (1.84, 7.91). Poor treatment outcome was three times higher among patients with longer duration of treatment (19-30months) (AOR = 3.23, 95%CI (1.82, 5.74) compared to patients with shorter duration of treatment (6-18 months). Patients with a negative smear test results and HIV positive patients were more likely to have poor treatment outcomes compared to patients with a smear-positive test result and HIV negative patients (AOR = 2.57, 95%CI (1.56, 4.22) and (AOR = 1.93, 95%CI (1.15, 3.23) (Table 3).
Table 3: Factors associated with MDR-TB treatment outcomes St. Peter Specialized Hospital, Addis Ababa, Ethiopia, 2019.
Characteristics
|
Treatment Outcome
|
COR (95 % CI)
|
AOR( 95 % CI)
|
P-Value
|
Poor
(No, %)
|
Good
(No, %)
|
Age (in years)
|
18-38
|
43(24.9)
|
35(16.6)
|
1
|
1
|
0.039*
|
39-60
|
130(75.1)
|
176(83.4)
|
1.66(1.01, 2.74)
|
0.43(0.19, 0.10)
|
Sex
|
Male
|
86(49.7)
|
53(25.1)
|
0.34(0.22, 0.52)
|
0.28(0.15, 0.52)
|
0.000*
|
Female
|
87(50.3)
|
158(74.9)
|
1
|
1
|
Weight (in Kg)
|
38-55
|
92(53.2)
|
110(52.1)
|
0.96(0.64, 1.43)
|
1.04(0.64, 1.69)
|
0.880
|
56-73
|
81(46.8)
|
101(47.9)
|
1
|
1
|
|
TB treatment history
|
New
|
148(85.5)
|
144(68.2)
|
1
|
1
|
0.205
|
Retreatment
|
25(14.5)
|
67(31.8)
|
2.75(1.65, 4.60)
|
1.53(0.79, 2.94)
|
Treatment resistance
|
First line
|
143(82.7)
|
145(68.7)
|
1
|
1
|
|
Second line
|
30(17.3)
|
66(31.3)
|
2.17(1.33, 3.54)
|
3.81((1.84, 7.91)
|
0.000*
|
Treatment duration
|
6-18months
|
62(35.8)
|
48(22.7)
|
1
|
1
|
0.000*
|
19-30months
|
111(64.2)
|
163(77.3)
|
1.90(1.21, 2.97)
|
3.23(1.82, 5.74)
|
Smear test result
|
Positive
|
120(69.4)
|
123(58.3)
|
1
|
1
|
0.000*
|
Negative
|
53(30.6)
|
88(41.7)
|
1.62(1.06, 2.47)
|
2.57(1.56, 4.22)
|
HIV Status
|
Positive
|
87(50.3)
|
143(67.8)
|
2.08(1.37, 3.15)
|
1.93(1.15, 3.23)
|
0.013*
|
Negative
|
86(49.7)
|
68(32.2)
|
1
|
1
|