Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Mar 26, 2016; 6(1): 118-125
Published online Mar 26, 2016. doi: 10.5662/wjm.v6.i1.118
Profile and determinants of unsuccessful tuberculosis outcome in rural Nigeria: Implications for tuberculosis control
Kingsley N Ukwaja, Sarah N Oshi, Isaac Alobu, Daniel C Oshi
Kingsley N Ukwaja, Department of Internal Medicine, Federal Teaching Hospital, Abakaliki 480281, Ebonyi State, Nigeria
Sarah N Oshi, Daniel C Oshi, Centre for Development and Reproductive Health, Enugu 400001, Enugu State, Nigeria
Isaac Alobu, National Tuberculosis and Leprosy Control Programme, Ministry of Health, Abakaliki 480001, Ebonyi State, Nigeria
Author contributions: Ukwaja KN, Oshi SN, Alobu I and Oshi DC designed the research; Ukwaja KN, Oshi SN, Alobu I and Oshi DC performed the research; Ukwaja KN and Oshi DC analyzed the data; Ukwaja KN, Oshi SN, Alobu I and Oshi DC wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics and Research Advisory Committee of the National Tuberculosis Control Programme, Ministry of Health, Ebonyi State, Nigeria.
Informed consent statement: As this was a retrospective study, the consent of the patients was not obtained, however, patient records was anonymized and de-identified prior to analysis.
Conflict-of-interest statement: The authors confirm that there are no conflict-of-interests to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at ukwajakingsley@yahoo.co.uk.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Kingsley N Ukwaja, MD, MWACP, Department of Internal Medicine, Federal Teaching Hospital, No 1 FMC Rd, Abakaliki 480281, Ebonyi State, Nigeria. ukwajakingsley@yahoo.co.uk
Telephone: +234-803-6243196
Received: August 29, 2015
Peer-review started: September 5, 2015
First decision: October 27, 2015
Revised: November 23, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 26, 2016
Processing time: 201 Days and 13.4 Hours
Abstract

AIM: To determine the treatment outcomes and predictors for unsuccessful tuberculosis (TB) outcomes in rural Nigeria.

METHODS: Adult rural TB patients treated during 2011 and 2012 in two healthcare facilities (one urban public and one rural private) were identified from the TB treatment registers and retrospectively reviewed. Tuberculosis treatment outcomes were assessed according to World Health Organisation guidelines. Determinants of unsuccessful treatment outcomes were identified using a multivariable logistic regression analysis.

RESULTS: Between January 2011 to December 2012, 1180 rural TB patients started treatment, of whom 494 (41.9%) were female. The treatment success rate was 893 (75.7%), while the rates of death, loss-to-follow-up, and treatment failure were 129 (10.9%), 100 (8.5%), and 18 (1.5%) respectively. In the final multivariable logistic regression model, the odds of unsuccessful treatment outcome were higher among patients who received care at the urban public facility (aOR = 2.9, 95%CI: 1.9-4.4), smear-negative (1.3, 1.0-1.8) and extrapulmonary (2.7, 1.3-5.6) TB patients, human immunodeficiency virus (HIV) co-infected (2.1, 1.5-3.0), and patient who received the longer (8-mo) anti-TB regimen (1.3, 1.1-1.8).

CONCLUSION: Treatment success among rural TB patient in Nigeria is low. High risk groups should be targeted for closer monitoring, socio-economic support, and expansion of TB/HIV activities.

Keywords: Tuberculosis; Treatment outcome; Rural; Health services; Nigeria

Core tip: Of 1180 tuberculosis (TB) patients enrolled, overall treatment success rate was 893 (75.7%). Also, death, default, and treatment failure rates were 10.9%, 8.5%, and 1.5%, respectively. Treatment success rate were significantly higher among all human immunodeficiency virus (HIV)-negative TB cases (79.3% vs 60.9%; P < 0.001). The difference was due to higher death rates among HIV-infected TB patients. Predictors of unsuccessful outcomes were; public facility-care, smear-negative or extrapulmonary TB, HIV co-infection, and receiving the 8-mo regimen.