Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a retrospective cohort study

2021 ◽  
Author(s):  
Leonard Kibirige ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Health Facilities ◽  
Capital City ◽  
Sub Saharan Africa ◽  
Tuberculosis Treatment ◽  
City Authority ◽  
Tb Control ◽  
Tb Treatment ◽  
Provider Perspectives

Abstract Introduction: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods: We conducted a retrospective cohort analysis of records for children <15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76-17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34-11.38). Conclusion: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. Treatment supporters of children with TB should be provided with detailed and consistent health education messages about TB treatment duration, the benefits of treatment completion, and risks of treatment discontinuation. The district and national TB control programs should address gaps in funding to TB care and the supply of TB drugs.

scholarly journals Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Leonard Kibirige ◽  
Jonathan Izudi ◽  
Stephen Okoboi
Keyword(s):  
Healthcare Providers ◽  
Health Facilities ◽  
Capital City ◽  
Sub Saharan Africa ◽  
Tuberculosis Treatment ◽  
Directly Observed Therapy ◽  
City Authority ◽  
Tb Control ◽  
Tb Treatment ◽  
Provider Perspectives

Abstract Introduction Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38). Conclusion Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.

Outcomes of tuberculosis treatment: a retrospective cohort analysis of smoking versus non-smoking patients in Penang, Malaysia

2010 ◽  
Vol 19 (2) ◽  
pp. 183-189 ◽  
Author(s):  
Juman Abdulelah Dujaili ◽  
Syed Azhar Syed Sulaiman ◽  
Ahmed Awaisu ◽  
Abdul Razak Muttalif ◽  
Ali Qais Blebil
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Tuberculosis Treatment ◽  
Retrospective Cohort Analysis

scholarly journals Treatment success for patients with tuberculosis receiving care in areas severely affected by Hurricane Matthew – Haiti, 2016

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247750
Author(s):  
Macarthur Charles ◽  
Milo Richard ◽  
Mary R. Reichler ◽  
Jean Baptiste Koama ◽  
Willy Morose ◽  
...  
Keyword(s):  
Treatment Success ◽  
Lessons Learned ◽  
Health Facilities ◽  
Hiv Status ◽  
Severe Damage ◽  
Convenience Sample ◽  
Tb Control ◽  
Tb Treatment ◽  
One Year ◽  
The Impact

Background On October 4, 2016, Hurricane Matthew struck southwest Haiti as a category 4 storm. The goal of this study was to evaluate the impact of the hurricane on tuberculosis (TB) services and patient outcomes in the three severely affected departments–Sud, Grand’Anse, and Nippes–of southwest Haiti. Methods We developed a standard questionnaire to assess a convenience sample of health facilities in the affected areas, a patient tracking form, and a line list for tracking all patients with drug-susceptible TB registered in care six months before the hurricane. We analyzed data from the national TB electronic surveillance system to determine outcomes for all patients receiving anti-TB treatment in the affected areas. We used logistic regression analysis to determine factors associated with treatment success. Results Of the 66 health facilities in the three affected departments, we assessed 31, accounting for 536 (45.7%) of 1,174 TB patients registered in care when Hurricane Matthew made landfall in Haiti. Three (9.7%) health facilities sustained moderate to severe damage, whereas 18 (58.1%) were closed for <1 week, and five (16.1%) for ≥1 week. Four weeks after the hurricane, 398 (73.1%) of the 536 patients in the assessed facilities were located. Treatment success in the affected departments one year after the hurricane was 81.4%. Receiving care outside the municipality of residence (adjusted odds ratio [aOR]: 0.46, 95% confidence interval [CI]: 0.27–0.80) and HIV positivity (aOR: 0.31, 95% CI: 0.19–0.51) or unknown HIV status (aOR: 0.49, 95% CI: 0.33–0.74) were associated with significantly lower rates of treatment success. Conclusions Despite major challenges, a high percentage of patients receiving anti-TB treatment before the hurricane were located and successfully treated in southwest Haiti. The lessons learned and results presented here may help inform policies and guidelines in similar settings for effective TB control after a natural disaster.

scholarly journals Patient Characteristics Associated with Non-Adherence to Anti Tuberculosis Treatment in Sri Lanka

2013 ◽  
Vol 9 (2) ◽  
pp. 19-25
Author(s):  
KAS Jayawardena ◽  
C Sarukkali ◽  
AKSB De Alwis ◽  
S Samaraweera ◽  
D Waidyaratne ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sri Lanka ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Patient Characteristics ◽  
Educational Background ◽  
Tuberculosis Treatment ◽  
Tb Control ◽  
Tb Treatment ◽  
Default Rate

Introduction: Sri Lanka had achieved a significant improvement in the tuberculosis control including a reduction of the default rate since introduction of the DOTS strategy to the National TB control Programme  in 1997. Patients’ adherence to anti TB treatment may be measured using either process oriented or outcome oriented definitions. Default rate is an outcome oriented definition that may be used as an indicator of poor patient adherence to anti TB treatment. One of the main obstacles in achieving the best  tuberculosis (TB) control is that patients do not complete full course of anti TB treatment. A prospective cohort study was carried out with the objective to identify patient characteristics that associate with defaulting anti tuberculosis treatment. Methodology: This was a prospective cohort study of new smear positive pulmonary tuberculosis patients registered for treatment between 1.6.2008 and 31.8.2008 in seven districts in Sri Lanka. Data on the patient characteristics and the plan of management were collected at the beginning of the treatment using a pre tested structured questionnaire. During the follow up and at the end of the treatment, results of sputum microscopy and the treatment outcome were recorded. The patients who interrupted treatment for 2 months or more (defaulters) during the course of treatment were again investigated in the field. In the statistical analysis, patient characteristics of the defaulters were compared with the characteristics of patients who were cured. Results: There were 22 defaulters giving a default rate of 4.59%. Being a male, poor educational background, having a casual job, regular smoking, and regular alcohol use were significantly associated with defaulting treatment (p < 0.05). Sinhalese had lower default rate than other ethnic groups. At the field investigation, 43% of the defaulters were found not living in the addresses given to the treatment providers. Field investigators have further reported that financial reasons, substance abuse, feeling well, and lack of family support also as causes of defaulting treatment. Conclusion: Identification of risk factors by careful patient interview, early home visit, and monitoring of patient behaviour early in the course of treatment will help to predict whether adherence is likely to be a  problem. So that, the treatment provider will be able to arrange a flexible and patient centered approach to ensure maximum adherence. SAARC Journal of Tuberculosis, Lung Diseases & HIV/AIDS; 2012; IX(2) 19-25 DOI: http://dx.doi.org/10.3126/saarctb.v9i2.7974

scholarly journals Delay for Tuberculosis Treatment and Its Predictors among Adult Tuberculosis Patients at Debremarkos Town Public Health Facilities, North West Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Yibeltal Estemech Ayalew ◽  
Fikadu Ambaw Yehualashet ◽  
Worknesh Akanaw Bogale ◽  
Mengistu Berhanu Gobeza
Keyword(s):  
Public Health ◽  
Rural Area ◽  
Traditional Healers ◽  
Health Facilities ◽  
Tuberculosis Treatment ◽  
Monthly Income ◽  
Tuberculosis Patients ◽  
North West ◽  
Tb Treatment ◽  
North West Ethiopia

Background. Delay in the diagnosis and treatment of tuberculosis exacerbates the disease and clinical outcomes. It further enhances transmission of the infection in the society as well as increased the severity of the illness and raised rate of mortality. Objectives. The major goal of this study is to determine the magnitude of delays in tuberculosis treatment and factors affecting tuberculosis treatment among adult tuberculosis patients at Debremarkos town, North West Ethiopia, 2018. Methods. Institution-based cross-sectional study design was employed. Systematically selected 300 adult TB patients were recruited to the study. The study was conducted at Debremarkos town public health facilities from March 1 to April 30, 2018. Logistic regression models were fitted to identify the predicting variables and control confounder’s of the outcome variables. P value ≤ 0.05 with 95% CI was considered as an indicator for the presence of statistically significant association. The result revealed that the median total delay was 23 days (IQR: 19-28 days). The median patient and health system delays were 20 days (IQR: 15-20 days) and 4 days (IQR: 3-5 days), respectively. Tuberculosis patients living in a rural area were 1.14 times more likely to delay for the TB treatment (AOR: 1.141, 95% CI (1.106, 2.608)). Patients who were unable to read and write have almost two times a chance of being delayed (AOR: 2.350, 95% CI (1.630, 2.608)). Monthly income of patients has found another predictor for delay; patients with low monthly income were about six times more likely to delay for TB treatment (AOR: 6.375, 95% CI: (1.733, 23.440)). Those TB patients who had visiting traditional healers before arrival to health facilities were about 2.7 times more likely to delay for TB treatment(AOR: 2.795, 95% CI (1.898, 8.693)). Conclusion and Recommendation. The significant proportion of delays in tuberculosis treatment was found in this study. Living in the rural area, unable to read and write, lower monthly income, and visiting traditional healers were found independent predictors of TB treatment delay. The regional and zonal health administrator shall design various awareness creation mechanisms to educate the public about timely initiation of tuberculosis treatment.

scholarly journals Retrospective cohort analysis of prescription patterns of cancer medications during periods of drug stockouts in Botswana

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049574
Author(s):  
Sonya Davey ◽  
Surbhi Grover ◽  
Warren B Bilker ◽  
Dipho I Setlhako ◽  
Tlotlo B Ralefala ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Kaposi Sarcoma ◽  
Sub Saharan Africa ◽  
Secondary Outcome ◽  
Cancer Drug ◽  
Breast Cancer Patients ◽  
Prescription Patterns ◽  
The Impact

ObjectiveCancer drug stockouts occur at high frequencies globally, however, their effects on treatment are understudied in sub-Saharan Africa (SSA). We aimed to determine whether causes of suboptimal cancer treatment prescriptions differed between periods of stockout and full treatment supply.DesignA retrospective cohort study of systemic therapy prescriptions for patients diagnosed with the twelve most common solid tumour cancers treated in 2016.SettingPrincess Marina Hospital in Gaborone, Botswana.ParticipantsPatients in the retrospective cohort who experienced any suboptimal treatment events, defined as ≥7 days delay or switch from guideline-concordant initiated therapy.Primary and secondary outcome measuresFrequency of delays and patterns of prescription changes for specific regimens and cancer types.Results167/378 patients contributed to 320 suboptimal events (115 therapy switches, 167 delays and 38 events with both), over 1452 total chemotherapy cycles received. Events during stockout were 43% delays, 43% switches and 14% both during stockout periods and 67.2% delays, 24.4% switches and 8.4% both during non-stockout periods (p<0.001). Majority of switches involved de-escalation of initially prescribed guideline-recommended regimens in patients with breast cancer, Kaposi sarcoma and patients with colorectal cancer, which occurred more frequently during periods of drug stockouts. Among patients with breast cancer, substitution of docetaxel for paclitaxel event occurred exclusively during paclitaxel drug stockout. Delays of ≥7 days events were most frequent in breast cancer patients receiving paclitaxel during stockout, and combination doxorubicin and cyclophosphamide even during periods of non-stockout.ConclusionsThe aetiology of suboptimal events differed during stockout and non-stockout periods. Prescription patterns that involved de-escalation of initiated therapy and substitution of paclitaxel with docetaxel occurred frequently during periods of drug stockout. Further research needs to be conducted to understand the impact of stockout on survival and barriers to maintaining essential cancer medicines supplies in SSA, and the factors driving frequent delays in therapy delivery.

Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis

2020 ◽  
Vol 72 (2) ◽  
Author(s):  
Silvia Alboresi ◽  
Alice Sghedoni ◽  
Giulia Borelli ◽  
Stefania Costi ◽  
Laura Beccani ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
Over Time
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