Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data

  • Francis Hamaimbo Nanzaluka Field Epidemiology Training Programme, Lusaka, Zambia; Ministry of Health, Lusaka, Zambia
  • Sylvia Chibuye Ministry of Health, Lusaka, Zambia
  • Clara Chola Kasapo Field Epidemiology Training Programme, Lusaka, Zambia
  • Nelia Langa Field Epidemiology Training Programme, Lusaka, Zambia; Ministry of Health, Lusaka, Zambia
  • Sulani Nyimbili Ministry of Health, Lusaka, Zambia
  • Given Moonga University of Zambia, Lusaka, Zambia
  • Nathan Kapata Ministry of Health, Lusaka, Zambia; 4Zambia National Public Health Institute, Lusaka, Zambia
  • Ramya Kumar
  • Gershom Chongwe University of Zambia, Lusaka, Zambia
Keywords: Surveillance; tuberculosis; treatment; outcome; Lusaka; Zambia

Abstract

Introduction: focus has been put on strengthening surveillance systems in high tuberculosis (TB) burden countries, like Zambia, however inadequate information on factors associated with unfavourable TB treatment outcomes is generated from the system. We determined the proportion of tuberculosis treatment outcomes and their associated factors.

Methods: we defined unfavourable outcome as death, lost-to-follow-up, treatment-failure, or not-evaluated and favourable outcome as a patient cured or completed-treatment. We purposively selected a 1st level hospital, an urban-clinic and a peri-urban clinic. We abstracted data from TB treatment registers at these three health facilities, for all TB cases on treatment from 1st January to 31st December, 2015. We calculated proportions of treatment outcomes and analysed associations between unfavourable outcome and factors such as age, HIV status, health facility, and patient type, using univariate logistics regression. We used multivariable stepwise logistic regression to control for confounding and reported the adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results: we included a total of 1,724 registered TB patients, from one urban clinic 694 (40%), a 1st Level Hospital 654 (38%), and one peri-urban-clinic 276 (22%). Of the total patients, 43% had unfavourable outcomes. Of the total unfavourable outcomes, were recorded as treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not evaluated (29%). The odds of unfavourable outcome were higher among patients > 59 years (AOR=2.9, 95%CI: 1.44-5.79), relapses (AOR=1.65, 95%CI: 1.15-2.38), patients who sought treatment at the urban clinic (AOR=1.76, 95%CI:1.27-2.42) and TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11-2.19).

Conclusion: unfavourable TB treatment outcomes were high in the selected facilities. We recommend special attention to TB patients who are > 59 years old, TB relapses and TB / HIV co-infected. The national TB programme should strengthen close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.

Published
2019-04-08
Section
Articles

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eISSN: 1937-8688