Lost to follow-up and associated factors among patients with drug resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

Background One third of global antmicrobial resistance deaths are attributed to drug resistant tuberculosis. Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis. There is a gap in nationally representative reliable information on lost to follow-up among patients with drug-resistant tuberculosis in Ethiopia. Objective To estimate the pooled prevalence and associated factors of lost to follow-up among patients with drug resistant tuberculosis in Ethiopia. Methods Observational studies searched from PubMed, HINARI and CINAHL were screened for eligibility. After assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q and I2. The random effects meta-analysis model was employed to pull the prevalence of lost to follow-up. Sub-group analysis and meta regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger’s and Begg’s tests. Sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The odds ratios were used to measure associations. Results The review was performed among 11 studies of which 9 were cohort studies. The sample sizes ranged from 90 to 612 and comprised a total of 3,510 participants. The pooled prevalence of lost to follow-up was 8.66% (95% CI, 5.01–13.14) with a high heterogeneity (I2 = 93.49%, p<0.001). Pulmonary multi-drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients. Conclusion There was a high prevalence of lost to follow-up among multi-drug resistant tuberculosis patients in Ethiopia. Anatomical site of tuberculosis was a significant factor affecting lost to follow-up. Strengthening the health care system and patient education should be given a due emphasis. Registration number CRD42020153326; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=153326.

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Extra Pulmonary Drug Resistant Tuberculosis Patients Were Less Likely to Lost From Follow-up: a Systematic Review and Meta-analysis

10.21203/rs.3.rs-144664/v1 ◽

2021 ◽

Author(s):

Assefa Andargie ◽

Asressie Molla ◽

Fentaw Tadese ◽

Segenet Zewdie

Keyword(s):

Meta Analysis ◽

Anatomical Site ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Resistant Tuberculosis ◽

Pooled Prevalence ◽

Extra Pulmonary ◽

Lost To Follow Up

Abstract Background: Lost to follow-up is one of the causes of the development of acquired drug resistant tuberculosis. There is a gap in nationally representative information on lost to follow-up among patients with drug-resistant tuberculosis in Ethiopia. Therefore, the objective of this study was to estimate the pooled prevalence and associated factors of lost to follow-up among patients with multi-drug resistant tuberculosis in Ethiopia.Methods: Observational studies searched from PubMed, HINARI and CINAHL were screened for eligibility. After assessing the quality of studies, data were extracted using a checklist. The forest plot, Q-statistics and I2 were used to assess heterogeneity. We employed the random effects meta-analysis model to estimate the pooled prevalence and effects. The sources of heterogeneity were investigated using sub-group analysis and meta regression. Funnel plot with Egger’s and Begg’s tests were employed to detect publication bias. Results: The review was performed among 11 studies of which 9 were cohort studies. The sample sizes ranged from 90 to 612 and comprised a total of 3,510 participants. The pooled prevalence of lost to follow-up was 8.66% (95% CI, 5.01-13.14) with a high heterogeneity (I2=93.49%, p<0.001). Pulmonary drug resistant tuberculosis patients were 50% less likely to loss from follow-up compared to extra pulmonary tuberculosis patients (OR= 0.50, 95% CI 0.27, 0.96). Conclusion: The prevalence of lost to follow-up among drug resistant tuberculosis patients in Ethiopia was substantial. Anatomical site of tuberculosis had a significant effect on lost to follow-up. Strengthening the health care system and patient education should be given a due emphasis.

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