Tuberculosis in Malaysia: predictors of treatment outcomes in a national registry

Liew, Su May; Khoo, Ee Ming; Ho, Bee Kiau; Lee, Y K; O, Mimi; Fazlina, Mohd Yusof; Razali, Asmah; Lee, W K; Harmy, M Y; Chinna, Karuthan; Jiloris, F.D.

doi:10.5588/ijtld.14.0767

Cited by 52 publications

(108 citation statements)

References 10 publications

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“…This is corroborated by similar research findings related to patients with previous episodes of TB in Limpopo (South Africa) [19], Uganda [29] and Malaysia [30]. In 2014, 6.7% of retreatment as opposed to 1.8% of new cases in South Africa had multidrug-resistant TB [4].…”

Section: Discussionsupporting

confidence: 68%

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

et al. 2017

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BackgroundSince 1990, reduction of tuberculosis (TB) mortality has been lower in South Africa than in other high-burden countries in Africa. This research investigated the influence of routinely captured demographic and clinical or programme variables on death in TB patients in the Free State Province.MethodsA retrospective review of case information captured in the Electronic TB register (ETR.net) over the years 2003 to 2012 was conducted. Extracted data were subjected to descriptive and logistic regression analyses. The outcome variable was defined as all registered TB cases with ‘died’ as the recorded outcome. The variables associated with increased or decreased odds of dying in TB patients were established. The univariate and adjusted odds ratios (OR and AOR) together with their corresponding 95% confidence intervals (CI) were estimated, taking the clustering effect of the districts into account.ResultsOf the 190,472 TB cases included in the analysis, 30,991 (16.3%) had ‘died’ as the recorded treatment outcome. The proportion of TB patients that died increased from 15.1% in 2003 to 17.8% in 2009, before declining to 15.4% in 2012. The odds of dying was incrementally higher in the older age groups: 8–17 years (AOR: 2.0; CI: 1.5–2.7), 18–49 years (AOR: 5.8; CI: 4.0–8.4), 50–64 years (AOR: 7.7; CI: 4.6–12.7), and ≥65 years (AOR: 14.4; CI: 10.3–20.2). Other factors associated with increased odds of mortality included: HIV co-infection (males – AOR: 2.4; CI: 2.1–2.8; females – AOR: 1.9; CI: 1.7–2.1) or unknown HIV status (males – AOR: 2.8; CI: 2.5–3.1; females – AOR: 2.4; CI: 2.2–2.6), having a negative (AOR: 1.4; CI: 1.3–1.6) or a missing (AOR: 2.1; CI: 1.4–3.2) pre-treatment sputum smear result, and being a retreatment case (AOR: 1.3; CI: 1.2–1.4).ConclusionsAlthough mortality in TB patients in the Free State has been falling since 2009, it remained high at more than 15% in 2012. Appropriately targeted treatment and care for the identified high-risk groups could be considered.

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Section: Discussionsupporting

confidence: 68%

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

et al. 2017

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“…This has been suggested to be related to HIV prevalence, especially advanced HIV disease, which is associated with low bacillary burden in the sputum 34. While extra-pulmonary TB has been associated with longer treatment delays,35 HIV infection36 and worse outcomes than pulmonary TB,26 higher treatment success among extra-pulmonary patients has also been reported 37. This depends partly on the site of extra-pulmonary disease; for example, meningeal and disseminated TB have higher mortality rates than lymphatic TB 38.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis treatment outcomes among disadvantaged patients in India

Jackson

Doshi

Pan

et al. 2017

public health action

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Setting: Urban slums and poor rural areas in India, 2012–2014.Objective: To describe the characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes.Design: This was a retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression, adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multidrug-resistant TB treatment, transfer out).Results: Of 8415 patients, 7148 (84.9%) had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common among men (OR 1.31, 95%CI 1.15–1.51), older patients (OR 1.12, 95%CI 1.04–1.21) and previously treated patients (OR 2.05, 95%CI 1.79–2.36). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely to have unfavourable outcomes (OR 0.72, 95%CI 0.60–0.87), while smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR 1.38, 95%CI 1.15–1.66 for low [scanty/1+] and OR 1.71, 95%CI 1.44–2.04 for high [2+/3+] positive smears).Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.

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“…Furthermore, a Malaysian study found that one fifth of TB patients registered in the national registry in 2012 had unfavourable outcomes. Lower education levels and HIV infection were found to be significant predictors of poor treatment outcomes (10). A study investigating the risk of TB diagnosis after recruitment into the TREAT Asia HIV Observational Database (TAHOD) reported TB incidence of 1.98 per 100 person-years of follow-up with younger age, lower CD4 cell count, antiretroviral therapy (ART) duration, and living high TB burden countries being significantly associated with the diagnosis of TB (11).…”

Section: Introductionmentioning

confidence: 99%

Socio-economic status and risk of tuberculosis: a case-control study of HIV-infected patients in Asia

Jiamsakul

Lee

Nguyen

et al. 2018

int j tuberc lung dis

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Setting Tuberculosis (TB) is the most common HIV-related opportunistic infection and AIDS-related death. TB often affects those from low socio-economic background. Objective This matched case-control study was designed to assess socio-economic determinants of TB in HIV-infected patients in Asia. Design HIV-positive-TB-positive cases were matched to HIV-positive-TB-negative controls according to age, sex and CD4 cell count. A socio-economic questionnaire consisting of 23 questions including education level, employment, housing and substance use, was distributed. Socio-economic risk factors for TB was analysed using conditional logistic regression analysis. Results A total of 340 patients (170 matched pairs) were recruited, with 262 (77.1%) matched on all three criteria. Pulmonary TB was the predominant type (115, 67.6%). The main risk factor for TB was not having university level education (OR=4.45, 95%CI (1.50-13.17), p=0.007). Burning wood or coal regularly inside the house and living in the same place of origin were weakly associated with TB diagnosis. Conclusions Our data suggests that lower socio-economic status is associated with increased risk of TB in Asia. Integrating clinical and socio-economic factors into the treatment of HIV may help in the prevention of opportunistic infections and disease progression.

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Tuberculosis in Malaysia: predictors of treatment outcomes in a national registry

Abstract: One fifth of TB patients had unfavourable outcomes. Intervention strategies should target those at increased risk of unfavourable outcomes and all-cause mortality.

Cited by 52 publications

References 10 publications

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

Risk factors for mortality in TB patients: a 10-year electronic record review in a South African province

Tuberculosis treatment outcomes among disadvantaged patients in India

Socio-economic status and risk of tuberculosis: a case-control study of HIV-infected patients in Asia

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