scholarly journals A study on predictors of treatment outcome among children registered under DOTS in district Tarn Taran, Punjab

2020 ◽  
Vol 32 (2) ◽  
pp. 399-403
Author(s):  
Pooja Sadana ◽  
Vishal Verma ◽  
Manisha Nagpal

Background: Globally, tuberculosis remains an important cause of morbidity and mortality for children. Diagnosis and management of childhood TB especially Extra pulmonary tuberculosis is challenging. Method:  A cross-sectional study was conducted on 0-14 year children who were registered and being treated, in district Tarn Taran, Punjab from 1st January 2018 to 31st December 2018. The treatment outcome with their clinico-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS. Results: Out of 62 registered patients, 62.9% of the children were in age group of 11-14 years. 67.7% were females. The various treatment outcomes observed were-cured 32.3%, treatment completed 61.3%, lost to follow up 1.6%, regimen changed 1.6%, not evaluated 3.2%. The success rate (cured+ treatment completed) was 93.6%. On statistical analysis, it was observed that age (p= 0.002), site of disease (p=0.000), contact history (p=0.012) and diagnostic method (0.000) was significantly associated with the treatment outcome whereas gender, area of residence and type of case had no association with the treatment outcome in children. Conclusions:  We also found that the overall treatment success rate was 93.6%. Increased focus be on those with household contact with TB.

Author(s):  
Melese Yeshambaw Teferi ◽  
Lukas Dingato Didana ◽  
Tsegaye Hailu ◽  
Simon Genet Woldesenbet ◽  
Senedu Bekele ◽  
...  

Background: Tuberculosis is a major public health problem throughout the world particularly in resource limited countries. Measuring and reporting of TB treatment outcomes and identifying associated factors are fundamental part of TB treatment. The aim of this study was to assess TB treatment outcome and associated factors among TB patients in Wolayta Sodo Teaching and Referral Hospital, Southern Ethiopia.Design and Methods: Facility based retrospective cohort study was conducted in Wolayta Sodo Teaching and Referral Hospital. All TB patients who registered during September 2014 to August 2019 and had known treatment outcome were included in the study. The data were collected using pretested structured data extraction format that included demographic, clinical and treatment outcome variables. SPSS Version 23 for windows was used for data processing. Bivariate and multivariate analysis with 95% confidence interval (CI) was employed to infer associations between the independent and dependent variables.Results: Of total 232 TB patient included in the study, 54.3% were male,80.2% were urban residents, 65.9% were pulmonary TB (PTB). From the total 153 PTB cases,31.5% were smear positive, 17.2% were HIV co-infected and all of them were on antiretroviral treatment. Most, 97.0% of the TB cases were newly diagnosed and all were treated as first line treatment category. The overall treatment success rate was 82.5% (28% cured 54.3% completed), 11.2% loss to follow-up, 4.7% dead and 0.9% treatment failure. The treatment success rate of HIV co-infected TB patients was 77.5%. There was no significant association between TB treatment outcome and age, sex, residence, type of TB, category of patients and HIV status.Conclusions: The treatment success rate was low (82.5%) which is below the90% threshold defined standard with high proportion of patient’s lost to follow-up (11.2%). A higher number of transfer-out cases were recorded in this study. Thus, supervision and monitoring of DOTs implementation, improved counseling service, mechanisms for lost to follow-up patients should be strengthen. Establish efficient referral and contact tracing mechanisms for transferred-out cases and document their treatment outcomes of status is also fundamental.


2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.


2020 ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Andrew James Codlin ◽  
Rachel Jeanette Forse ◽  
Hoa Trung Nguyen ◽  
Thanh Nguyen Vu ◽  
...  

Abstract Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7). Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [95% CI: 0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [95% CI: 1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [95% CI: 1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [95% CI: 0.89-0.96], p<0.001), relapse patients (aRR=0.89 [95% CI: 0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [95% CI: 0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [95% CI: 0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [95% CI: 1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β6)=1.07 [95% CI: 1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β6)=0.17 [95% CI: 0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7)=0.90 [95% CI: 0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.


Author(s):  
Seup Park ◽  
Ilham Sentissi ◽  
Seung Gil ◽  
Won-Seok Park ◽  
ByungKwon Oh ◽  
...  

Non-adherence to tuberculosis (TB) treatment is a barrier to effective TB control. We investigated the effectiveness of a Medication Event Monitoring System (MEMS) as a tailored adherence-promoting intervention in Morocco. We compared patients who received a MEMS (n = 206) with patients who received standard TB care (n = 141) among new active TB patients with sputum smear-positive. The mean total medication days were 141.87 ± 29.5 in the control group and 140.85 ± 17.9 in the MEMS group (p = 0.7147), and the mean age and sex were not different between the two groups (p > 0.05). The treatment success rate was significantly higher in the MEMS group than in the control group (odds ratio (OR): 4.33, 95% confidence interval (CI): 2.13–8.81, p < 0.001), and the lost to follow-up rate was significantly lower in the MEMS group than in the control group (OR: 0.03, 95% CI: 0.05–0.24, p < 0.001) after adjusting for sex, age, and health centers. The mean drug adherence rate in the first month was significantly higher in the MEMS group than in the control group (p = 0.023). MEMS increased TB treatment success rate and decreased the lost to follow-up rate overall for infectious TB patients in a Moroccan rural area.


Author(s):  
Wan Nurul Ezyani Wan Jabarudin ◽  
Normala Mohammad Som ◽  
Afidatul Mardhiah Mohammad Daud ◽  
Nor Dalila Shamsuddin ◽  
Nazian Hanna Yaacob ◽  
...  

Background: The objective of this study is to determine the success rate of oral methotrexate in Hospital Shah Alam for the past 2 years.Methods: This is a cross-sectional study using secondary data obtained from medical record office in Hospital Shah Alam on patients with ectopic pregnancy. A total of 35 patients who fulfilled the criteria for medical management were selected. They were prescribed with oral methotrexate with the dose of 60 mg given in 3 divided doses every 2 hours using the standard tablet of 2.5mg. Follow up was done at day 4, day 7 and till HCG level achieve less than 20 iu/litre.Results: 29 patients were successfully treated with oral methotrexate 60 mg (82.8%). Another 6 patients had to undergo laparoscopic surgery with confirmed leaking, ruptured tubal pregnancy. 4 patients needed second dose of Methotrexate due to rising HCG level and all of them were successfully treated after the second dose. The side effects of oral methotrexate were tolerated well by all patients. There are numbers of predictors for success which are the level of HCG <4000 iu/litre, size of mass <4cm, no abdominal pain during early presentation and decrease of HCG level in between day 4 to day 7 after oral methotrexate.Conclusions: The success rate of oral methotrexate for stable ectopic pregnancy is good making it a suitable option for clinical settings which has no specialised equipment to handle cytotoxic drugs.


2020 ◽  
Vol 24 (10) ◽  
pp. 1016-1023
Author(s):  
H. W. Kim ◽  
J. Min ◽  
A. Y. Shin ◽  
H-K. Koo ◽  
S. Y. Lim ◽  
...  

BACKGROUND: As there had been no reduction in the TB burden in South Korea since 2000, a public-private mix (PPM) strategy was launched in 2011. The purpose of this study was to investigate the reasons for lost to follow-up (LTFU) among TB patients and their clinical characteristics.METHOD: A multicentre, cross-sectional study based on in-depth interviews with patients and their families by TB specialist nurses was conducted. Patients who were reported with a final outcome of LTFU in 2015–2017 at all PPM hospitals across the country were enrolled. Enrolled patients were classified into six subgroups by age and three major reasons for LTFU (adverse effects, refusal of treatment, marginalisation) and their clinical features were compared.RESULTS: Among 780 patients, those who were lost to follow-up due to adverse effects accounted for the largest proportion (n = 387). LTFU in those aged <65 years who refused treatment (n = 189) and those aged <65 years who were marginalised (n = 108) were related to having smear-positive TB and a previous history of unfavourable outcomes.CONCLUSION: To reduce LTFU in South Korea, comprehensive strategies, including management of adverse effects, systematic counselling and education, should be implemented.


2016 ◽  
Vol 14 (2) ◽  
pp. 187-191 ◽  
Author(s):  
Daniel A London ◽  
Jeffrey G Stepan ◽  
Charles A Goldfarb ◽  
Martin I Boyer ◽  
Ryan P Calfee

Background: In clinical research, minimizing patients lost to follow-up is essential for data validity. Researchers can employ better methodology to prevent patient loss. We examined how orthopedic surgery patients’ contact information changes over time to optimize data collection for long-term outcomes research. Methods: Patients presenting to orthopedic outpatient clinics completed questionnaires regarding methods of contact: home phone, cell phone, mailing address, and e-mail address. They reported currently available methods of contact, if they changed in the past 5 and 10 years, and when they changed. Differences in the rates of change among methods were assessed via Fisher’s exact tests. Whether participants changed any of their contact information in the past 5 and 10 years was determined via multivariate modeling, controlling for demographic variables. Results: Among 152 patients, 51% changed at least one form of contact information within 5 years, and 66% changed at least one form within 10 years. The rate of change for each contact method was similar over 5 (15%–28%) and 10 years (26%–41%). One patient changed all four methods of contact within the past 5 years and seven within the past 10 years. Females and younger patients were more likely to change some type of contact information. Conclusion: The type of contact information least likely to change over 5–10 years is influenced by demographic factors such as sex and age, with females and younger participants more likely to change some aspect of their contact information. Collecting all contact methods appears necessary to minimize patients lost to follow-up, especially as technological norms evolve.


Author(s):  
Tsegay Legesse ◽  
Mohammed Hussein Elduma ◽  
Nagi Masoud Awad ◽  
Mousab Siddig Elhag ◽  
Israa Abushama ◽  
...  

Background: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017. Methods: This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment. Results: A total of 710 TB cases of which 53.4% were men, 22.1% children (<15 years), and 36.2% extrapulmonary TB (EPTB) were registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome. Conclusion: The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.


2019 ◽  
Author(s):  
Saima Iqbal Paracha ◽  
Fahad Hafeez ◽  
Hammad Habib ◽  
Aashifa Yaqoob ◽  
Raazia Fatima ◽  
...  

Abstract Background The HIV epidemic in Pakistan is concentrated in key populations and is one of the fastest growing epidemics in South Asia. Over the years the number of people infected with the human immunodeficiency virus initiated on antiretroviral therapy has gradually increased. The effectiveness of the treatment programmes depends on retention in care and treatment adherence. The aim of the study is to the explore the sociodemographic characteristics and magnitude of loss to follow-up in patients initiated on ART in three provinces of Pakistan.Methods A retrospective cross-sectional study was conducted in the National AIDS Control Programme. Case-based data (n=5,215) of 16 treatment centres for all patients initiated on anti-retroviral therapy from 1 st January 2017 to 31 st December 2018 was extracted from the national management information system. Loss to follow-up was defined as a patient who has not visited/attended the ART clinic for >180 days (6 months) and has not been reported dead or transferred out to another ART clinic. Descriptive statistics were applied to study the sociodemographic characteristics and level of lost to follow up in patients initiated on treatment.Results Of the 5,215 patients, 3,097 (59.4%) were aged between 15-49 years. About 4,069 (78%) were male. Around 1,686 (34.3%) of the patients on ART were defined as lost to follow up. Age, gender, and patients with undisclosed identity were identified as the key characteristics of patients lost to follow-up. A greater proportion of the patients were lost to follow-up within the first year of initiation of treatment.Conclusions The loss to follow in the study is high. Efforts need to be focussed on linking people infected with human immunodeficiency virus to treatment, retaining them in care, and increasing patient time on treatment. Patient tracing mechanisms should be strengthened.


2015 ◽  
Vol 9 (07) ◽  
pp. 752-759 ◽  
Author(s):  
Eyasu Ejeta ◽  
Muda Chala ◽  
Gebeyaw Arega ◽  
Kassahu Ayalsew ◽  
Lensa Tesfaye ◽  
...  

Introduction: Treatment outcome is an important indicator of tuberculosis control programs, as suggested by the World Health Organization. However, this has not been well documented in the study area. This work contributes to a better understanding this issue. Methodology: A five-year (2009–2013) retrospective cohort study was conducted between April and May 2014, in six randomly selected health institutions providing tuberculosis treatment in western Ethiopia. Bivariate and multivariate logistic regression analyses were used to assess the association between treatment outcomes and predictor variables. Results: A total of 1,175 tuberculosis patients with a mean (standard deviation) age of 29.91 (13.99) were involved in the study. The majority of the study participants had smear-negative pulmonary tuberculosis (39.7%) and extrapulmonary tuberculosis (39.7%). Of all the study participants, 14.5% were cured, 56.3% completed treatment, 0.2% had treatment failure, 8.1% died during follow-up, 7.1% were reported as defaulters, and 13.8% were transferred out to another health institution. The overall treatment success rate was 70.8% and show progressive increases over the course of the study. The associated predictors were enrollment years, HIV co-infection, and sputum smear follow-up in the second, fifth, and seven months. Conclusions: The treatment success rate was unsatisfactory in spite of improvement seen over the study period. Thus, continued follow-up of patients, with frequent supportive supervision during the course of treatment, and provision of early detection and follow-up for HIV infection need to be strengthened to achieve an effective treatment outcome.


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