Factors associated with unsuccessful treatment outcome in tuberculosis patients among refugees and their surrounding communities in Gambella Regional State, Ethiopia

Abstract

BackgroundTuberculosis (TB) is a leading cause of public health challenges among immigrant refugees and their surrounding communities in developing countries. Evaluating the treatment outcome of TB patients is one of the key indicators to understand the performance of TB control program. Hence, this study aims to assess profile, treatment outcome and factors associated with unsuccessful outcome of TB patients treated under the TB control program among refugees and their surrounding communities (SCs) in Gambella Regional State, Ethiopia.MethodologyRetrospective study was conducted in the health facilities of refugee and their SCs in Gambella Regional State from March 1 to May 30, 2017. Demographic and related data of all TB patients registered in TB Control Program between September, 2008 and October, 2017 in health facilities of refugee and the SCs was extracted using data extraction format. Eight years trend of TB, treatment outcome and factors associated with unsuccessful outcome among refugees and the SCs were computed using SPSS version 20.0 software.ResultA total of 886 refugees and 3284 SCs TB patients, registered for anti TB treatment in the last eight years, were evaluated in the study. The trend of all forms of TB is progressively increasing among refugees contrary to the SCs in the course of the study period (X2 trend = 207.7; P<0.0001). Smear positive pulmonary TB (PTB+) was found to be predominant (57.6%) TB form in refugees while smear negative pulmonary TB (PTB-) (44.8%) is in the SCs (X2 = 185.834; P<0.0001). There was also significant difference in the treatment outcome (X2 = 170.915; P<0.0001). Mean treatment success rate was 74.2% and 88.1% for refugees and the SCs, respectively (X2 = 92.887; P<0.0001). The study also revealed that the risk of unsuccessful TB treatment outcome was significantly higher among refugee (AOR = 2.17; 95% CI: 1.69–2.77), retreated cases (AOR = 1.53; 95% CI: 1.07–2.17), patients aged between 35–44 years (AOR = 1.38; 95% CI: 1.0–1.91), and greater than 44 years old (AOR = 1.77; 95% CI: 1.28–2.44), and patients with extra pulmonary TB (EPTB) form (AOR = 1.34; 95% CI: 1.04–1.73) compared to their counterparts. Patient coming from rural area (AOR = 0.77; 95% CI: 0.62–0.97), who are female (AOR = 0.76; 95% CI: 0.63–0.91) and TB/HIV non-infected (AOR = 0.63; 95% CI: 0.51–0.77) were more likely to be successfully treated.ConclusionThe study confirmed that there was low treatment success rate among refugees compared to the SCs. Being refugee, retreated case, patient’s age ≥35 years old, EPTB form, gender, rural patient address and HIV status were predictor factors for unsuccessful treatment outcome. Hence, the study urges the need for strengthened TB prevention program among refugees with due consideration of identified predictor factors to prevent the potential effect of hosting refugee to the SCs and the nations at large.

<p>Trend Analysis And Seasonality Of Tuberculosis Among Patients At The Hiwot Fana Specialized University Hospital, Eastern Ethiopia: A Retrospective Study</p>

“…The trend of TB positivity rate in this study gradually decreased consecutively throughout the study period, at 19.3% in 2015, 18.6% in 2016, 18.4% in 2017, 13.5% in 2018, and 13% in 2019. This finding is consistent with a report from Agaro and Nekemte in Ethiopia, 7,19 and in China 21 in which the trend of TB steeply declined. But it was contradicted with a study from Gambella, West Ethiopia 22 and in Nigeria, 23 in which the trend of TB fluctuated year to year.…”

“…Moreover, among those with low socio-economic status, living conditions, poor nutrition, and lack of awareness to seek early diagnosis, TB is ranked as the third most common cause of hospital admission and the second most common cause of death from the top ten diseases in Ethiopia. [5][6][7] Even though TB was not well defined as a seasonal variation in different countries, some reports revealed that a peak of TB cases occurred in the summer 8,9 and spring, 10,11 while it was lower in December and a peaked in July in Uganda, 12 with a rise in autumn in Ethiopia. 13 TB was confirmed to be a seasonal disease with a low rate in the second and high in the fourth quarter of the calendar year in Ethiopia.…”

Tuberculosis Treatment Outcomes Among Prisoners and General Population in Zomba, Malawi

“…A common risk factor for unsuccessful TB treatment outcome, Extra Pulmonary TB was also found in this study. This might be due to the severe nature of the EPTB, delays in diagnosing EPTB [22] due limited diagnostic capacity and lack of treatment monitoring tests for EPTB cases [23].…”

Tuberculosis (TB) in the Refugee Camps in Ethiopia: Trends of Case Notification, Profile, and Treatment Outcomes, 2014 to 2017

“…In the refugee camps in Ethiopia, the number of noti ed TB cases was continuously increased from 138 in 2014 to 588 cases in 2017. Similarly, a study done in the refugee population in Gambella Region, Ethiopia, showed 29.0% increase in noti ed TB cases in eight years (2009-2017) [8], whereas another study done in Ethiopia showed a 90.4% increment in CNR of TB cases of all forms in 15 years (1997-2011) [12].…”

“…However, due to poor shelter and living conditions, poor health and nutritional status, overcrowding, and inadequate access to TB care and prevention, the burden and severity of TB is higher in migrants, refugees and displaced populations (DPs) [3][4][5][6]. Moreover, the risk of acquiring multi-drug resistant (MDR) TB and unsuccessful TB treatment outcome is higher among refugees [7,8]. In order to end to TB by 2030, therefore, strengthen TB care and prevention in refugee and displaced population has been listed as one of the ten components of the End TB strategy by world health organization (WHO) [2].…”