Extra Pulmonary Drug Resistant Tuberculosis Patients Were Less Likely to Lost From Follow-up: a Systematic Review and Meta-analysis

Abstract

Background: Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis. There is a gap in nationally representative information on lost to follow-up among patients with drug-resistant tuberculosis in Ethiopia. Therefore, the objective of this study was to estimate the pooled prevalence and associated factors of lost to follow-up among patients with multi-drug resistant tuberculosis in Ethiopia.Methods: Observational studies searched from PubMed, HINARI and CINAHL were screened for eligibility. After assessing the quality of studies, data were extracted using a checklist. The forest plot, Q-statistics and I2 were used to assess heterogeneity. We employed the random effects meta-analysis model to estimate the pooled prevalence and effects. The sources of heterogeneity were investigated using sub-group analysis and meta regression. Funnel plot with Egger’s and Begg’s tests were employed to detect publication bias. Results: The review was performed among 11 studies of which 9 were cohort studies. The sample sizes ranged from 90 to 612 and comprised a total of 3,510 participants. The pooled prevalence of lost to follow-up was 8.66% (95% CI, 5.01-13.14) with a high heterogeneity (I2=93.49%, p<0.001). Pulmonary drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients (OR= 0.50, 95% CI 0.27, 0.96). Conclusion: The prevalence of lost to follow-up among drug resistant tuberculosis patients in Ethiopia was substantial. Anatomical site of tuberculosis had a significant effect on lost to follow-up. Strengthening the health care system and patient education should be given a due emphasis.