Journal of
Public Health and Epidemiology

  • Abbreviation: J. Public Health Epidemiol.
  • Language: English
  • ISSN: 2141-2316
  • DOI: 10.5897/JPHE
  • Start Year: 2009
  • Published Articles: 511

Article in Press

SURVIVAL AND PREDICTORS OF MORTALITY FROM MULTIDRUG RESISTANT TUBERCULOSIS (MDR-TB) AMONG PATIENTS TREATED AT MDR-TB REFERAL HOSPITALS IN ETHIOPIA: A RETROSPECTIVE COHORT STUDY

Mulugeta Shegaze Shimbre , Tamiru Shibru Degaga, Sultan Hussen Hebo, Zerihun Zerdo

  •  Received: 01 March 2019
  •  Accepted: 05 July 2019
Background: According to the World Health Organization (WHO), in 2015, there were an estimated 10.4 million new TB cases, 1.4 million TB deaths and another 0.4 million deaths among people with TB and HIV. The treatment of multi-drugs resistance tuberculosis (MDR-TB) with second line drugs is long, complex and costly, and has a considerable rate of adverse effects. The extent and burden of MDR-TB varies significantly from country to country. According to WHO 2015 report only 50% of the MDR-TB and 26% of extensively drug-resistant tuberculosis (XDR-TB) patients in the 2012 cohort of detected cases were successfully treated. In Africa, fewer than half of patients receiving therapy for multidrug-resistant TB (MDR TB) are successfully treated. Even though MDR-TB treatment was started in 2009, survival of MDR-TB treatment particularly of adverse treatment outcome is not studied in national level. Methods: Institution based retrospective cohort study was conducted at randomly selected four Treatment Initiation Centers (TIC) & referral hospitals in Ethiopia. Data was collected using standardized checklist by trained professionals through reviewing records of all patients ever enrolled. Data was cleaned and entered by Epi info version 7 and analyzed by SPSS version 20 and STATA. Cox- proportional hazard regression model was built and variables that had P-value < 0.25 in bivariate analysis considered candidates for multivariate analysis to determine independent predictors of mortality by using P-value < 0.05 and presented with hazard ratio. Result: of the 494 records reviewed, 462 met the inclusion criteria. These patients were followed for 202250 person-day of observation; during the follow up period 38 (8.2%) patients were died making overall incidence density 6.79 (95% CI=5.42-8.78) per 100 Person year. Survival at the end of 1st and 4th month was 98.2% and 92.3% respectively, while the overall mean survival time was 24.82(95%CI=22.8-25.72) months. Drugs side effect 3 (95 % CI [2.5-4.3]), medical diagnosis other than TB and HIV 3.3 (95 % CI [1.7-5.6]), HIV sero-status 2.7 (95 % CI [3.4-9.11]) and bigger base line body were independently and significantly predicted mortality of MDR-TB patients. Conclusion and recommendation: The incidence of death and treatment outcomes was in acceptable ranges, yet it needs due attention. Intervention to further reduce deaths has to focus on patients with comorbidities, HIV, adverse effect and smaller base line body weight.

Keywords: comorbidities, HIV, adverse effect and smaller base line body weight.