Predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia

by Demelash Woldeyohannes, Tesfaye Assefa, Rameto Aman, Yohannes Tekalegn, Zeleke Hailemariam

Background

Multidrug-resistant tuberculosis (MDR-TB) is a man-made problem when bacteria are resistant to at least two anti TB drugs (Rifampicin and Isoniazid). Currently from tuberculosis infected patients, two out of ten are developing MDR-TB and it is an emerging public health problem in Ethiopia. Despite high burden of MDR-TB in Ethiopia, the treatment outcomes and predictors related to incidence among MDR-TB patients is not studied in Oromia region, Ethiopia. Therefore, the present study assessed the predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia

Method

Facility based retrospective cohort study was conducted at hospitals in Oromia Region. All registered MDR-TB patient charts from 2015 to 2017 were considered for the study. Data entry was done by using EPI data version 3.1 Statistical Software and data analysis was done by SPSS version 20. The descriptive statistics, frequency, median and range were employed. Bivariate and multivariate Cox proportional hazard regression analysis was used to identify predictors of time to unfavorable treatment outcomes of multidrug resistant tuberculosis. In multivariate Cox proportional hazard regression analysis, the variables with P- value less than and equal to 0.05 were considered as predictor variables for time to unfavorable treatment outcome of MDR-TB.

Result

From the total of 415 (92.84%) complete MDR-TB charts, the overall cumulative probability of unfavorable treatment outcome at the end of the treatment (two years) was 21.21%. In multivariate Cox proportional hazard analysis initial culture result [AHR = 0.52; 95% CI: 0.29, 0.96], HIV test result [AHR = 3.76; 95% CI: 2.45, 5.78] and culture at the end of continuation phases [AHR = 0.12; 95% CI: 0.08, 0.20] were the predictors of unfavorable treatment outcome.

Conclusion

The magnitude of unfavorable treatment outcome at Oromia hospitals was lower than WHO regional report of 2018. This finding demonstrated that low unfavorable treatment outcomes for MDR-TB patients can be achieved in a resource-constrained and high TB-burden setting. Whereas, Initial culture result, HIV test result and culture at the end of continuation phases were determined as predictor factors with associated unfavorable treatment outcomes. Culture positive and HIV positive MDR-TB patients need special attention at the time of treatment.