Survival Status and Predictors of Mortality among Patients with Multi-Drug Resistant Tuberculosis Treated in Treatment Initiating Centers Ethiopia, 2018: A Retrospective Cohort Study

  • Anti-microbial resistance
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Multi-drug-resistant tuberculosis (MDR-TB) is an urgent global public health crisis. In 2017, there were an estimated 558,000 new cases of MDR-TB, which caused 230,000 deaths globally. Ethiopia is among the 30 high MDR-TB burden countries as well the prevalence of MDR-TB in Tigray is high. However, little is known about the survival and predictors of mortality among patients with MDR-TB in our study area. We estimated survival status and identified predictors for MDR-TB mortality and the findings can be used as an input to design effective interventions that might help to reduce morbidity and mortality in Tigray Region.
We conducted a retrospective cohort study in patients with MDR-TB enrolled for treatment in seven Treatment Ini- tiation Centers (TICs) from February, 2013 to April, 2018. Data were collected consecutively by using pre-tested data abstraction forms. All relevant variables were extracted from patient registration log books and patient cards. Data were entered and analyzed using STATA version 12 and Results: were presented using tabular frequency and graphs. A cox proportional hazard regression model was built, the final result was interpreted using adjusted hazard ratio (AHR) with 95% CI and Statistical significance was declared at p-value <0.05.
We enrolled 387 patients, followed for a total of 486.8 person- years. The median age at initiation of treatment was 30 years (IQR=24-40). More than half of the patients, 223(57.6%) were males. During five years follow- up period 47(12.1%) patients died, resulting in an incidence rate of 9.6 deaths per 100 person-years in the cohort. The mean survival time was 1.9 years, with overall survival rate of 86.2% at the end of two years. HIV-infection [AHR=2.3, 95%CI =1.1-4.7], presence of commodities [AHR =2.7, 95%CI =1.2-6.03], adverse drug events [AHR=2.6, 95%CI=.2- 5.65], and sputum culture non-conversion [AHR=7.7, 95%CI =3.6-16.5] independently predicted mortality.
The survival time of MDR-TB patients was low and the overall incidence rate of death was high. In addition, HIV-co- infection, commodities other than HIV, drug adverse effects and lack of sputum culture conversion at two months were factors associated with mortality. Targeted interventions are needed to reduce deaths among those were MDR-TB patients.

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