Treatment outcomes and associated factors among pulmonary Tuberculosis patients in Moyo and Obongi District

Abstract

Background: The World Health Organization estimates that in 2017, approximately 10 million people had tuberculosis (TB), and 1.6 million people died due to the disease. Globally none of the high TB burden countries has managed to achieve both targets of 90% treatment coverage and 90% treatment success. TB treatment success rate (TSR) for Uganda was at 70%, and that of the former Moyo district (now did into Moyo and Obongi districts) was reported to be at 78.6%. And currently, the factors associated with the treatment outcomes and reasons for unsuccessful treatment outcomes were not known. Objective: To determine the treatment outcomes and associated factors among pulmonary tuberculosis (PTB) patients in Moyo and Obongi Districts from July 2016 to June 2019. Methods: This was a retrospective cross-sectional study using records 3 years aggregated cohort of PTB patients in Moyo and Obongi districts enrolled on treatment between July 2016 to June 2019. A data abstraction sheet was used to extract data on 566 cases from the TB treatment registers. Treatment outcomes were dichotomized as successful treatment outcomes and unsuccessful treatment outcomes. A modified poison regression model with a 5% level of significance was used to analyze possible associations between the treatment outcomes and independent variables. The confidence interval was set at 95% for all statistical tests. A telephone interview was used to obtain qualitative data from 16 TB patients who had unsuccessful treatment and content analysis was used to identify the reasons for unsuccessful treatment outcomes. Results: The treatment success rate was 77.0% (95% CI:73.4-80.3). The proportion of patients who were cured was 43.8%(95% CI:39.8-48.0). The treatment completion rate was 33.2% (95% CI: 29.0-37.2), while the death rate among PTB patient was 7.2% (95%CI: 5.4-9.7). Defaulter rate was 0.9% (95% CI: 0.4-2.1), treatment failure rate was 0.2% (95% CI: 0.0-1.2), 4.4% (95% CI:3.0-6.5) were lost to follow-up and 10.3% (95% CI:8.0-13.0) were transfer outs. Long-distance of 10 Km and more to health facility 10-15Km (RR=1.197, p-value=0.005), 16-20Km (RR=1.327, p-value=<0.001), 20+Km (RR=1.292, p-value=<0.001), facility-based treatment modality (RR=1.232, p-value=0.008), follow up smear not done (RR=1.357, p-value=<0.001), being a refugee (RR=1.0695, p-value=0.004), sputum smear negative (RR=0.846, p-value=0.017) were statistically associated with unsuccessful treatment outcomes. The reasons for unsuccessful treatment outcomes revealed by this current study were change of location, lack of family support, feeling of being cured, distance to the health facility, drug side effect, and long treatment duration. Conclusion: The treatment success rate of PTB (77.0%) is still below the target (90%) although it is higher than the national average (70%). The big number of unsuccessful treatment outcomes was due to transfer out of TB Patients from the facility from which treatment was initiated. MoH/NTLP should empower the Village Health Teams to make follow-ups patients in their area to reduces the number of lost to follow-up and drug defaulter, design an electronic system that tracks the records of TB patients from the different treatment centers. This can reduce the cases reported as lost to follow-up but continue with treatment from other treatment centers and should integrate a cross-border referral system into a TB patient management system to help a patient who moves from one country to another to adequately get help.