Profile and determinants of treatment failure among smear-positive pulmonary tuberculosis patients in Ebonyi, Southeastern Nigeria

Alobu, Isaac; Oshi, Daniel C.; Oshi, Sarah N; Ukwaja, Kingsley Nnanna

doi:10.1016/j.ijmyco.2014.02.005

Cited by 11 publications

(6 citation statements)

References 8 publications

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“…Smear status of TB patients was associated with treatment success at private DOTS facilities similar to findings from study from Nigeria which reported that positive sputum smears was associated with treatment failure 31 Smear negative pulmonary TB patient are known to have the lower bacillary burden and minimal pulmonary lesion which would imply that they probably responded to chemotherapy better than smear positive TB patients. 32…”

Section: Discussionsupporting

confidence: 77%

Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria

Adejumo

Daniel

Otesanya³

et al. 2017

Niger Med J

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Background:The engagement of private practitioners in the public-private mix of tuberculosis (TB) management started in 2007 in Lagos State Nigeria. This study compared the treatment outcomes of patients managed at private for profit (PFP) and private not for profit (PNFP) directly observed treatment short course (DOTS) facilities.Methods:A retrospective review of treatment cards of TB patients managed between January 1, 2012, and June 30, 2012, in seven PFP and four PNFP DOTS facilities that served as treatment and microscopy center under the Lagos State TB and Leprosy Control Programme (LSTBLCP) at least 2 years before data collection was conducted.Results:A total of 372 treatment cards of TB patients were reviewed, of which 132 (35.5%) and 240 (64.5%) were from PFP and PNFP DOTS facilities, respectively. Treatment success rate was higher among patients managed at PFP (89.4%) DOTS facilities than PNFP (81.3%) DOTS facilities (P = 0.04). The proportion of patients lost to follow-up (12.5% vs. 8.3%), dead (3.3% vs. 1.5%) and treatment failure (2.5% vs. 0.8%) was higher among patients managed at PNFP DOTS facilities (P > 0.05). The odds that patients treated at PFP DOTS facilities had treatment success were about four times higher than PNFP DOTS facilities when other variables have been controlled for (P < 0.05).Conclusion:There is need by the LSTBLCP to engage more private practitioners to increase case detection and improve treatment outcomes of TB patients.

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Section: Discussionsupporting

confidence: 77%

Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria

Adejumo

Daniel

Otesanya³

et al. 2017

Niger Med J

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“…Contrary to evidences in developed countries where TB affects mostly the extreme of the ages (the very young and old) due to lower immunities, it affects mostly the productive age groups in developing countries as seen in this study. These findings are corroborated by other studies in Nigeria [22,23] and contribute significantly to worsening effects of the medical and socio-economic burden of the disease. The types (categories) of patients at enrolment are proxy indications of the effectiveness of TB case detection and patients' management in the program.…”

Section: Discussionsupporting

confidence: 87%

Progress Towards TB Elimination: An Eight-Year Retrospective Analysis of Key Performance Indicators for TB Control in Plateau State, Nigeria, 2016

Ibrahim¹

2017

CAJPH

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Tuberculosis is a major public health concern in Nigeria. It had been targeted for elimination using the directly observed treatment short Couse strategy. Plateau state started implementing the strategy since 2001. The key performance indicators towards achieving elimination targets was evaluated. Data from the routine surveillance records and reports from 2008 to 2015 were extracted. Patients' enrollment, sputum conversion, treatment outcomes and TB/HIV co-infection was analyzed using epiInfo software. Of the 23,532 registered cases, only 34% were new sputum smear positive. The introduction of XpertMTB/Rif technology in 2013 increased the proportion of patient with pulmonary TB diagnosed bacteriologically by 11%. Majority (89%) of the smear positive cases were in the productive age group of 15 -54 years. TB/HIV co-infection was 39.6%, with more female than male (OR 2.41, 95% CI: 2.22 -2.63). The cured rate increased from 57.3% in 2008 to 70.1% in 2014. The overall treatment success and death rates were 83.0% and 6.6% respectively. Deaths and treatment failure rates were lower among new pulmonary smear positive patients (OR 0.68, 95% CI 0.52 -0.88 and OR 0.47, 95% CI 0.29 -0.77) respectively. The deaths were higher among TB/HIV compared to HIV negative patients (OR 2.23,. Despites the improvements in the performance indicators, the state is yet to achieve the elimination targets. Expansion of the use of Xpert technology, Community awareness, patient education and prompt defaulter retrieval will ensure early detection and enrollment of cases, improve quality of diagnosis and outcomes of TB treatment in the state.

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“…In relation to cohort and case–control studies, the total NOS scores ranged from 5 to 9, signifying included studies were of good quality. A score of 5 was recorded in a case–control49 and a retrospective cohort study,50 a score of 7 was found in one retrospective51 and another prospective cohort study,52 a score of 8 was found in four studies (two prospective cohort53 54 and two retrospective cohort studies,55 56 while each of the remaining 16 studies scored 9 (see online supplementary table 3). With respect to risk of bias in RCTs using the Cochrane’s collaboration tool, we found low risk of bias on the selection domain for the RCTs57–60 except in one RCT60 where it was high (see online supplementary figure 1).…”

Section: Resultsmentioning

confidence: 99%

Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis

et al. 2019

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ObjectivesTo summarise treatment success rate (TSR) among adult bacteriologically confirmed pulmonary tuberculosis (BC-PTB) patients in sub-Saharan Africa (SSA).DesignWe searched MEDLINE, EMBASE, Google Scholar and Web of Science electronic databases for eligible studies published in the decade between 1 July 2008 and 30 June 2018. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. We used random-effects model to pool TSR in Stata V.15, and presented results in a forest plot with 95% CIs and predictive intervals. We assessed heterogeneity with Cochrane’s (Q) test and quantified with I-squared values. We checked publication bias with funnel plots and Egger’s test. We performed subgroup, meta-regression, sensitivity and cumulative meta-analyses.SettingSSA.ParticipantsAdults 15 years and older, new and retreatment BC-PTB patients.OutcomesTSR measured as the proportion of smear-positive TB cases registered under directly observed therapy in a given year that successfully completed treatment, either with bacteriologic evidence of success (cured) or without (treatment completed).Results31 studies (2 cross-sectional, 1 case–control, 17 retrospective cohort, 6 prospective cohort and 5 randomised controlled trials) involving 18 194 participants were meta-analysed. 28 of the studies had good quality data. Egger’s test indicated no publication bias, rather small study effect. The pooled TSR was 76.2% (95% CI 72.5% to 79.8%; 95% prediction interval, 50.0% to 90.0%, I2statistics=96.9%). No single study influenced the meta-analytical results or conclusions. Between 2008 and 2018, a gradual but steady decline in TSR occurred in SSA but without statistically significant time trend variation (p=0.444). The optimum TSR of 90% was not achieved.ConclusionOver the past decade, TSR was heterogeneous and suboptimal in SSA, suggesting context and country-specific strategies are needed to end the TB epidemic.PROSPERO registration numberCRD42018099151.

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Profile and determinants of treatment failure among smear-positive pulmonary tuberculosis patients in Ebonyi, Southeastern Nigeria

Abstract: This study showed that the treatment failure rate among smear-positive TB patients is low in Nigeria. Education and improved clinical and laboratory interventions for the identified at-risk groups may reduce TB treatment failure in resource-limited settings.

Cited by 11 publications

References 8 publications

Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria

Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria

Progress Towards TB Elimination: An Eight-Year Retrospective Analysis of Key Performance Indicators for TB Control in Plateau State, Nigeria, 2016

Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis

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