Factors Determining Treatment Success in Children with Drug-Sensitive Tuberculosis in Ethiopia: A Three-Year Retrospective Analysis

Abstract

This study in the Amhara and Oromia regions of Ethiopia assessed the outcomes of tuberculosis (TB) treatment among children younger than 15 years. Retrospective data were collected on treatment outcomes and their determinants for children with TB for the cohorts of 2012-2014 enrolled in 40 hospitals and 137 health centers. Chi-square tests, t-tests, and logistic regression were used for the analysis. Of 2,557 children registered, 1,218 (47.6%) had clinically diagnosed pulmonary TB, 1,100 (43%) had extrapulmonary TB, and 277 (8.9%) had bacteriologically confirmed TB. Among all cases, 2,503 (97.9%) were newly diagnosed and 178 (7%) were HIV positive. Two-thirds of the children received directly observed treatment (DOT) in health centers and the remaining one-third, in hospitals. The treatment success rate (TSR) was 92.2%, and the death rate was 2.8%. The childhood TSR was high compared with those reported in focal studies in Ethiopia, but no national TSR report for children exists for comparison. Multivariate analysis showed that being older-5-9 years (adjusted odds ratio [

Determinants of tuberculosis treatment outcomes in Asia and Africa

“…Women are known to show better treatment outcomes as well as lower dropout rates and mortality. Seven other studies identified HIV status as a determinant of treatment outcomes (García-Basteiro et al, 2016;Habte et al, 2020;Khazaei et al, 2016;Ogbudebe et al, 2018;Oladimeji et al, 2021;Tesema et al, 2020;Umeokonkwo et al, 2020). Negative HIV status increases the likelihood of a successful treatment outcome.…”

“…Internal factors consist of 11 determinants from within the TB patient, namely age, gender, education, HIV status, TB location, treatment category, alcohol consumption, drug use, smoking, type of ARB (Acid Resistant Bacteria), and comorbidities (Ahmad et al, 2020;Atif et al, 2014;Babalik et al, 2014;Banerjee et al, 2020;DesJardin et al, 2020;García-Basteiro et al, 2016;Habte et al, 2020;Khazaei et al, 2016;Mohammadzadeh et al, 2016;Mulogo et al, 2017;Muluye et al, 2018;Mundra et al, 2019;Ogbudebe et al, 2018;Oladimeji et al, 2021;Sadana et al, 2020;Sahyog et al, 2018;Son et al, 2021;Tesema et al, 2020;Tetteh et al, 2018;Umeokonkwo et al, 2020;Wen et al, 2018). 13 articles described age as an internal factor for TB treatment outcomes (Ahmad et al, 2020;Atif et al, 2014;Babalik et al, 2014;Habte et al, 2020;Mundra et al, 2019;Ogbudebe et al, 2018;Oladimeji et al, 2021;Sadana et al, 2020;Son et al, 2021;Tesema et al, 2020;Tetteh et al, 2018;Umeokonkwo et al, 2020;Wen et al, 2018). The likelihood of a successful treatment outcome was higher among patients aged 15-24 years, compared to patients younger than 14 years (Tesema et al, 2020), and over 61 years (Ahmad et al, 2020;Habte et al, 2020).…”

“…13 articles described age as an internal factor for TB treatment outcomes (Ahmad et al, 2020;Atif et al, 2014;Babalik et al, 2014;Habte et al, 2020;Mundra et al, 2019;Ogbudebe et al, 2018;Oladimeji et al, 2021;Sadana et al, 2020;Son et al, 2021;Tesema et al, 2020;Tetteh et al, 2018;Umeokonkwo et al, 2020;Wen et al, 2018). The likelihood of a successful treatment outcome was higher among patients aged 15-24 years, compared to patients younger than 14 years (Tesema et al, 2020), and over 61 years (Ahmad et al, 2020;Habte et al, 2020). The determinants of TB treatment outcomes can be seen in Table 2.…”

“…External factors are determinants that originate from outside or from the TB patient's environment. Based on a review of all articles, eight external factors were found to be determinants of TB treatment outcomes, including the location of health care facilities, DOTS (Directly Observed Treatment Shortcourse) program, diagnosis method, contact history, year of diagnosis, discrimination, counseling, and attitude of medical staff (Ahmad et al, 2020;Banerjee et al, 2020;DesJardin et al, 2020;Habte et al, 2020;Mulogo et al, 2017;Muluye et al, 2018;Ogbudebe et al, 2018;Oladimeji et al, 2021;Sadana et al, 2020;Sahyog et al, 2018;Tesema et al, 2020). External factors were identified by 11 articles.…”

“…External factors were identified by 11 articles. (Atif et al, 2014;Babalik et al, 2014;Banerjee et al, 2020;García-Basteiro et al, 2016;Khazaei et al, 2016;Mohammadzadeh et al, 2016;Muluye et al, 2018;Mundra et al, 2019;Oladimeji et al, 2021;Sahyog et al, 2018;Son et al, 2021) (Ahmad et al, 2020;Atif et al, 2014;Mundra et al, 2019;Oladimeji et al, 2021;Sadana et al, 2020;Son et al, 2021;Tetteh et al, 2018;Wen et al, 2018) (García-Basteiro et al, 2016Habte et al, 2020;Khazaei et al, 2016;Ogbudebe et al, 2018;Oladimeji et al, 2021;Tesema et al, (Mulogo et al, 2017) Three articles identified health facility location as a determinant of treatment outcomes (DesJardin et al, 2020;Sahyog et al, 2018;Tesema et al, 2020). Patients who are close to a health facility, namely located less than five kilometers away, have better treatment outcomes than those who are far from the treatment location (Tesema et al, 2020).…”