Visceral leishmaniasis treatment outcome and its determinants in northwest Ethiopia

Abstract

OBJECTIVESPoor treatment outcomes of visceral leishmaniasis (VL) are responsible for the high mortality rate of this condition in resource-limited settings such as Ethiopia. This study aimed to identify the proportion of poor VL treatment outcomes in northwest Ethiopia and to evaluate the determinants associated with poor outcomes.METHODSA hospital-based retrospective study was conducted among 595 VL patients who were admitted to Kahsay Abera Hospital in northwest Ethiopia from October 2010 to April 2013. Data were entered into Epi Info version 7.0 and exported to SPSS version 20 for analysis. Bivariate and multivariate logistic regression models were fitted to identify the determinants of VL treatment outcomes. Adjusted odds ratio (aORs) with 95% confidence intervals (CIs) were used, and p-values <0.05 were considered to indicate statistical significance.RESULTSThe proportion of poor treatment outcomes was 23.7%. Late diagnosis (≥29 days) (aOR, 4.34; 95% CI, 2.22 to 8.46), severe illness at admission (inability to walk) (aOR, 1.63; 95% CI, 1.06 to 2.40) and coinfection with VL and human immunodeficiency virus (HIV) (aOR, 2.72; 95% CI, 1.40 to 5.20) were found to be determinants of poor VL treatment outcomes.CONCLUSIONSPoor treatment outcomes, such as death, treatment failure, and non-adherence, were found to be common. Special attention must be paid to severely ill and VL/HIV-coinfected patients. To improve VL treatment outcomes, the early diagnosis and treatment of VL patients is recommended.

Incidence of mortality and its predictors among adult Visceral Leishmaniasis patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia

“…Accordingly, the overall incidence rate of mortality was 6.6 (95% CI 5.2 - 8.4) per 1000 person-days of observation, with most of deaths (60%) occurring within the first 10 days of follow-up period, which requires the attention of health workers in these periods. The proportion of death among VL patients in this study was 11.09 % (95% CI: 10.85% - 13.6%), which is in line with a study conducted in Kahsay Abera Hospital(12.4%) [9]. This similarity might be due to the similarity in quality of care given for VL patients in these Hospitals, as these Hospitals use similar visceral leishmaniasis treatment guideline.…”

“…The sample size for this study was calculated through Stata 14 software using 12.4 % probability of an event (death) in another similar setting [9], 80 % power, hazard ratio of two, 5% significance level, and 10 % for incomplete data. Accordingly, the final sample size of the study was 586.…”

“…A patient who started VL treatment but interrupted treatment due to the patient leaving the Hospital during the study period [9,15,31].…”

“…When we came to Ethiopia, mortality rate among severely ill adult VL patients is 4.8 % [7] and it is 14 % among VL-HIV co-infected adults [8]. Another two cross sectional studies shoes that the proportion of death among VL patients is 12.4% in Kahsay Abera Hospital [9] and 18.5% in Tigray region [10].…”

“…Predictors of mortality among VL patients include: presence of drug toxicity [15], malnutrition [3,16,17], VL-HIV co-infection [5,9,17–24],thrombocytopenia [5,11,18–21,25], leukopenia [5,18–21,26], jaundice [5,18–21,26], relapsing course of the disease [11,22,25], high parasite load [8,27,28], renal failure(creatinine>1.5 mg/dl)[20,26], diarrhea [10,11,25], bleeding [5,10,18–21], anemia [11,17,25], inability to walk at admission [9], longer duration of illness [17], concomitant disease [5,18–21], late diagnosis [6,9,29] and edema [5,18–21].…”