Patient factors related to pre-treatment delay of pulmonary tuberculosis: A retrospective cohort study in Bangladesh

ObjectivesTo characterise adoption and explore specific clinical and patient factors that might influence pulse oximetry and oxygen use in low-income and middle-income countries (LMICs) over time; to highlight useful considerations for entities working on programmes to improve access to pulse oximetry and oxygen.DesignA multihospital retrospective cohort study.SettingsAll admissions (n=132 737) to paediatric wards of 18 purposely selected public hospitals in Kenya that joined a Clinical Information Network (CIN) between March 2014 and December 2020.OutcomesPulse oximetry use and oxygen prescription on admission; we performed growth-curve modelling to investigate the association of patient factors with study outcomes over time while adjusting for hospital factors.ResultsOverall, pulse oximetry was used in 48.8% (64 722/132 737) of all admission cases. Use rose on average with each month of participation in the CIN (OR: 1.11, 95% CI 1.05 to 1.18) but patterns of adoption were highly variable across hospitals suggesting important factors at hospital level influence use of pulse oximetry. Of those with pulse oximetry measurement, 7% (4510/64 722) had hypoxaemia (SpO2 <90%). Across the same period, 8.6% (11 428/132 737) had oxygen prescribed but in 87%, pulse oximetry was either not done or the hypoxaemia threshold (SpO2 <90%) was not met. Lower chest-wall indrawing and other respiratory symptoms were associated with pulse oximetry use at admission and were also associated with oxygen prescription in the absence of pulse oximetry or hypoxaemia.ConclusionThe adoption of pulse oximetry recommended in international guidelines for assessing children with severe illness has been slow and erratic, reflecting system and organisational weaknesses. Most oxygen orders at admission seem driven by clinical and situational factors other than the presence of hypoxaemia. Programmes aiming to implement pulse oximetry and oxygen systems will likely need a long-term vision to promote adoption, guideline development and adherence and continuously examine impact.

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Mortality among pulmonary tuberculosis and HIV-1 co-infected Nigerian children being treated for pulmonary tuberculosis and on antiretroviral therapy: a retrospective cohort study

GERMS ◽

10.11599/germs.2016.1099 ◽

2016 ◽

Vol 6 (4) ◽

pp. 139-150 ◽

Cited By ~ 2

Author(s):

Augustine O Ebonyi ◽

Stephen Oguche ◽

Oche O Agbaji ◽

Atiene S Sagay ◽

Prosper I Okonkwo ◽

...

Keyword(s):

Cohort Study ◽

Antiretroviral Therapy ◽

Pulmonary Tuberculosis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Nigerian Children ◽

Hiv 1

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Treatment response and predictors in patients with newly diagnosed epilepsy in Ethiopia: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-019-52574-y ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Kidu Gidey ◽

Legese Chelkeba ◽

Tadesse Dukessa Gemechu ◽

Fekede Bekele Daba

Keyword(s):

Cohort Study ◽

Treatment Response ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards Model ◽

Medical Center ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Newly Diagnosed ◽

Pre Treatment

Abstract Epilepsy is a chronic neurological disease with a variable therapeutic response. To design effective treatment strategies for epilepsy, it is important to understand treatment responses and predictive factors. However, limited data are available in Africa, including Ethiopia. The aim of this study was therefore to assess treatment response and identify prognostic predictors among patients with epilepsy at Jimma university medical center, Ethiopia. We conducted a retrospective cohort study of 404 newly diagnosed adult epilepsy patients receiving antiepileptic treatment between May 2010 and May 2015. Demographic, clinical, and outcome data were collected for all patients with a minimum follow-up of two years. Cox proportional hazards model was used to identify predictors of poor seizure remission. Overall, 261 (64.6%) of the patients achieved seizure remission for at least one year. High number of pre-treatment seizures (adjusted hazard ratios (AHR) = 0.64, 95% CI: 0.49–0.83) and poor adherence (AHR = 0.57, 95% CI: 0.44–0.75) were significant predictors of poor seizure remission. In conclusion, our study showed that only about two-thirds of patients had achieved seizure remission. The high number of pre-treatment seizures and non-adherence to antiepileptic medications were predictors of poor seizure remission. Patients with these characteristics should be given special attention.

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