Last modified: 2019-02-13
Abstract
Background: The emergency of drug resistant tuberculosis is a major public health threat, however, little is known about predictors of survival of drug resistant tuberculosis cases in Amhara region, even in Ethiopia. This study aimed to describe the treatment outcome, determine the survival status and its predictors in drug resistant tuberculosis patients in Amhara region, Ethiopia.
Methods: Institutional based retrospective cohort study was carried out among laboratory confirmed drug resistant TB patients (n=498) who registered for second-line anti-tuberculosis treatment from September 1 through December 31 2017. Information on relevant variables was collected from patients’charts and registries. Data were analysed using Stata Version 14.1. Kaplan-Meier was used to estimate the cumulative survival of the patients. Log rank test was used to compare the survival function of the patient based on different baseline categorical variables. Cox proportional model was fitted to compute hazard ratios with their 95% confidence interval. Proportionality assumption was tested by global test based on scheonfeld residuals. Goodness of fit of the final model was checked by Nelson Aalen cumulative hazard function against Cox Snell residual.
Results: A total of 498 with a median age of 29.30 of [IQR: 23-41] years were analysed. The overall treatment success rate of 498 study participants was 61.41% (cure 54.13% treatment completion 7. 28%). About 14.7% deaths were reported in the follow up time with incidence rate of 8.20 [95% CI=7.62-20.50] per 1000 Person-months. Cigarette smoking (Adjusted Hazard Ratio (AHR)= 1.39: 95%CI:1.27, 3.18], Tuberculosis related complication [AHR=9.31 95%CI: 5.11, 16.97], anaemia [AHR=3.04 95%CI: 1.14, 9.20], HIV Positive [AHR=1.34 95%CI: 1.25, 3.35], and diabetes mellitus [AHR=1.8595% CI: 1.24, 5.71] were predictors of time to mortality.Conclusion: There was a high rate of early mortality of DR-TB patients. Patients with TB related clinical complications, with baseline anaemia, HIV positive, diabetes mellitus and history of smoking were predictors of time to mortality in the course of DR-TB therapy.There should be close follow up in the early phase of treatment of patients with DR-TB
Keyword: survival status, Mortality, second line, Amhara region, predictors