Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

Ncube, Ronald; Takarinda, Kudakwashe C; Zishiri, C.; Boogaard, Wilma van den; Mlilo, N.; Chiteve, C; Siziba, Nicholas; Trinchán, F; Sandy, Charles

doi:10.5588/pha.17.0024

Cited by 27 publications

(26 citation statements)

References 16 publications

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“…Patients over 50 were less likely to have favorable treatment outcomes (12.4% vs. 27.0%) ( Table 1). Ncube et al (2017) found that the elderly had worse treatment outcomes compared to younger cohorts of patients, which is congruent with our study 21 . This study also indicated that worse outcomes may be due to other immunosuppressant conditions and age-related diseases 21 .…”

Section: Discussionsupporting

confidence: 92%

“…Ncube et al (2017) found that the elderly had worse treatment outcomes compared to younger cohorts of patients, which is congruent with our study 21 . This study also indicated that worse outcomes may be due to other immunosuppressant conditions and age-related diseases 21 . This is evidence that other comorbid conditions may create unique challenges for the treatment of older MDR-TB patients.…”

Section: Discussionsupporting

confidence: 92%

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Understanding how geographic, demographic and treatment history impact health outcomes of patients with multi-drug-resistant tuberculosis in Pakistan, 2014–2017

Iqbal

Defer

Latif³

et al. 2020

Epidemiol. Infect.

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Tuberculosis (TB) is one of the top 10 leading causes of morbidity and mortality worldwide [1]. In 2017, approximately 10 million people were infected with TB and 1.3 million patients faced mortality [1]. Patients with active TB can infect up to 10–15 people over a year. There is a greater risk of transmission in overcrowded areas with limited air ventilation including large family units, prisons and slums [1, 2]. Without proper diagnosis and treatment, roughly 45% of non-HIV positive TB patients face mortality [1]. With the help of global organizations and national TB treatment and control programmes, the global incidence of TB is declining by approximately 2% each year [1]. The World Health Organization (WHO) TB-strategy aims to end the TB epidemic and encourages partners to fund national TB programmes to improve diagnosis and treatment of TB. The goal is to ultimately decrease death rates by 90% and decrease incidence rates by 80% [1]. To achieve these goals, the decline in TB incidence needs to reach approximately 4–5% per year [1]. The WHO 2018 TB report identified multidrug resistant TB (MDR-TB) as the leading factor hindering that goal [1]. The incidence and spread of MDR-TB has drastically increased, where approximately 558 000 new cases of MDR-TB were diagnosed in 2017 causing more than 230 000 deaths globally [1]. MDR-TB is identified by resistance to the two most powerful anti-TB treatment drugs including isoniazid and rifampicin [3]. Patients with MDR-TB are required to start second-line anti-TB drugs (SLDs), which are limited, expensive, less effective and more toxic [1,2]. Therapy duration is one of the major limitations of second-line treatments, which may require up to two years of consistent use. Since TB affects mostly developing countries, long treatment durations and associated costs become a major challenge. In 2015, 15% of new TB cases were reported as MDR-TB, which drastically increased to 24% by 2017 [1]. Even with significant improvements in molecular tests and diagnostic methods, MDR-TB is still on the rise where the success rate of treatments is between 50 and 60% [1]. Additional characteristics including socioeconomic and sociocultural factors need to be considered when targeting and treating patients with MDR-TB.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Understanding how geographic, demographic and treatment history impact health outcomes of patients with multi-drug-resistant tuberculosis in Pakistan, 2014–2017

Iqbal

Defer

Latif³

et al. 2020

Epidemiol. Infect.

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“…The odds of successful treatment outcome decrease with advancing age, this is comparable with the study in Zimbabwe on age-stratified tuberculosis treatment outcomes, where the elderly had a poorer treatment outcome compared to the younger patients. 29 This might be due to better immune response among the younger age group and probably other associated comorbidities among the older age group. Duration of incarceration was significantly associated with successful treatment outcome, this is similar to the finding among inmates in Ethiopia prisons.…”

Section: Resultsmentioning

confidence: 99%

Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

Amede¹,

Adedire²,

Usman³

et al. 2020

Preprint

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Background : Tuberculosis (TB) is a contagious disease and its transmissibility potential is increased in congregate settings like the prisons. TB incidence rates are five to fifty times higher among prison inmates than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its predictors in Nigerian prisons. We therefore assessed TB treatment outcomes among prison inmates in Bauchi State, Nigeria. Method: We conducted a retrospective data analysis of inmates with TB in the five main prisons in Bauchi State. We extracted sociodemographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a standardized checklist. We estimated the TB treatment success rate (TSR) and explored the relationship between the TSR and sociodemographic and clinical characteristics. Related variables were modelled in multiple logistic regression to identify predictors of TSR at 5% level of significance. Results: All 216 inmates were male with mean (SD) age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 48 (22.2%) were lost to follow-up, 17 (7.9%) were transferred out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Predictors of successful treatment outcome were age; 20-29 years (AOR=10.5; 95% CI: 3.2-35.1), 30-39 years (AOR=4.2; 95% CI: 1.3-13.1), pretreatment weight; ≥ 55kg (AOR= 13.3; 95% CI: 6.0-29.6), imprisonment for ≤ 2 years (AOR= 2.6; 95% CI: 1.3-5.4) and being HIV negative (AOR=3.3; 95% CI:1.4-7.8). Conclusion: The predictors of successful TB treatment outcome were being less than 40 years of age, having a pretreatment body weight of or greater than 55 kg, imprisonment for less than 2 years, and being HIV negative. We recommended that to improve TB TSR among prison inmates; age, duration of imprisonment, weight and TB/HIV co-infection should be the major consideration during pretreatment, psychological and nutritional counselling and a tracking system be developed by the prisons authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated.

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“…Similarly, a study in Ethiopia revealed that pretreatment weight category of 55.0-70.9kg and ≥71.0kg were significantly associated with successful treatment outcome. 34 This might be explained by undernutrition which increases the risk of advanced TB disease and lowers immune response, resulting to poor treatment outcome. This study revealed that TB/HIV coinfection was associated with poor treatment outcome.…”

Section: Discussionmentioning

confidence: 99%

“…This is in contrast to finding among prison inmates in northern Ethiopia where HIV coinfection was not associated with treatment outcomes but similar to that in Ethiopian university hospital. 26,34 This could be attributed to the immune compromised associated with both disease, poor adherence to drugs due to large daily pills intake and the negative drug-to-drug interaction between Anti-TB and Anti-Retroviral drugs.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

Amede¹,

Adedire²,

Usman³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Tuberculosis (TB) is a contagious disease and its transmissibility potential is increased in congregate settings like the prisons. TB incidence rates are five to fifty times higher among prison inmates than the general population which has a direct impact on the outcome of TB treatment. There is paucity of information on TB treatment outcomes and its predictors in Nigerian prisons. We therefore assessed TB treatment outcomes among prison inmates in Bauchi State, Nigeria. Method: We conducted a retrospective data analysis of inmates with TB in the five main prisons in Bauchi State. We extracted sociodemographic, clinical and treatment outcome characteristics from TB treatment register of inmates treated for TB between January 2014 and December 2018, using a standardized checklist. We estimated the TB treatment success rate (TSR) and explored the relationship between the TSR and sociodemographic and clinical characteristics. Related variables were modelled in multivariate logistic regression to identify predictors of TSR at 5% level of significance. Results: All 216 inmates were male with mean age of 37.6±11.4 years. Seventy-six (35.2%) were cured, 61 (28.2%) completed treatment, 48 (22.2%) were lost to follow-up, 17 (7.9%) were transferred out without evaluation and 14 (6.5%) died. Overall TSR was 72.9%. Odds of successful treatment outcome were age; 20-29 years (AOR=10.5; 95% CI: 3.2-35.1), 30-39 years (AOR=4.2; 95% CI: 1.3-13.1), pretreatment weight; 50-59 kg (AOR= 9.6; 95% CI: 1.4-65.6), ≥60 kg (AOR= 18.6; 95% CI: 2.5-140.1) and being HIV negative (AOR=3.3; 95% CI:1.4-7.8). Conclusion: The predictors of successful TB treatment outcome were being less than 40 years of age, having a pretreatment body weight of or greater than 50 kg, imprisonment for less than 2 years, and being HIV negative. We recommended that to improve TB TSR among prison inmates; age, duration of imprisonment, weight and TB/HIV coinfection should be the major consideration during drugs adherence, psychological and nutritional counselling and a tracking system be developed by the prisons authority to follow-up inmates transferred-out to other health facilities to ensure they complete the treatment and outcomes evaluated. Key words: Tuberculosis, Treatment outcomes, Prison inmates, Predictors, Bauchi State, Nigeria

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Age-stratified tuberculosis treatment outcomes in Zimbabwe: are we paying attention to the most vulnerable?

Cited by 27 publications

References 16 publications

Understanding how geographic, demographic and treatment history impact health outcomes of patients with multi-drug-resistant tuberculosis in Pakistan, 2014–2017

Understanding how geographic, demographic and treatment history impact health outcomes of patients with multi-drug-resistant tuberculosis in Pakistan, 2014–2017

Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

Treatment outcomes of drug-susceptible tuberculosis and its predictors among male prison inmates in Bauchi State, Nigeria, 2014-2018

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