http://www.annalsafrmed.org/article.asp?
issn=15963519;year=2009;volume=8;issue=2;spage=100;epage=104;aulast=Fatiregun
Year : 2009 | Volume : 8 | Issue : 2 | Page : 100-104
Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan,
Nigeria
Akinola A Fatiregun, Abimbola S Ojo, Afolabi E Bamgboye
Department of Epidemiology, Medical Statistics and Environmental Health, Faculty of Public
Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
On multivariate logistic regression, factors that were found to predict poor treatment outcomes
included male gender (adjusted RR 1.8; 95% CI: 1.62-1.94) and poor knowledge of TB (adjusted
RR 1.35; 95% CI: 1.25-1.62; [Table 3]).
Discussion
Any treatment outcome in which a cure is not established, i.e. sputum conversion to negative
among active TB cases, will pose a danger to the community; hence, prevention of such
occurrences is necessary to maximize the efficiency of TB control programs. The finding herein
that TB primarily affects the young age group was consistent with previous reports in developing
countries. [5],[11],[12] However, TB has been reported to be two-to-four times more prevalent among
the elderly age group in developed countries. [13] Also, the observation that a greater percentage
(55%) of the patients in this cohort was males is consistent with other reports. [4],[14] TB is closely
associated with poor living conditions, poverty, and low socioeconomic status. Although the
majority of the patients in this study were employed (94.3%) and had a post-primary education
(58.9%), most (72.2%) were earning < N15, 000.00 a month. This is consistent with the report
from Ife [5] in which low socioeconomic status, overcrowding, and poor living conditions were
identified as major risk factors in the development of pulmonary TB.
The cure rate of 76.6% found in this study is below the recommended target of 85% by the
WHO. [3] Even if those who were transferred out were cured, the cure rate may not have been
better than was estimated. The HIV status of the patients was not known because HIV screening
tests were not routinely carried out; hence, our estimate could not be attributed to the prevalence
of the infection among the study population. However, the estimated cure rate is close to the cure
rate of 73% among pulmonary TB patients in the Obafemi Awolowo University Teaching
Hospital (OAUTH) in Ile Ife. [5] The cure rate varied significantly between the treatment centers.
The treatment centers with the lowest and highest cure rates were manned by primary health care
workers. Cure rates of 50 and 75% were found for treatment centers located within the specialist
hospitals at Jericho and the UCH, respectively. Although the care patients received in these
centers may not necessarily represent TB management in the community, it is thought to be
superior given that these are tertiary health centers. There is thus a need to study health centrespecific challenges to a high cure rate in our environment. In Montreal, [1] for example, it was
found that university-affiliated centers adhered to recommended standard treatments only some
of the time (in 25% of cases the initial treatment was a regimen not considered standard by
current guidelines).
The data revealed that males are at an increased risk of a poor treatment outcome compared to
females. This is consistent with other published reports. [15],[16] Lienhardt et al, in 1998, reported
that females were more likely to achieve a cure than their male counterparts. [15] Similarly, Diel et
al, attributed poor treatment outcomes, such as default, failure, and death, to males. [16] Also, the
risk of a poor treatment outcome was higher among those with poor knowledge. This is
consistent with the report by Jaramillo that non-compliance and other treatment outcomes are
associated with poor education of patients on TB therapy. [17] It is also consistent with the
findings of Khan et al, that low knowledge of TB and therapy is a predictive factor of adverse
treatment outcome among TB patients. [18]
In conclusion, the findings provide a useful insight in understanding challenges to treatment
outcomes. The cure rate among smear-positive pulmonary TB patients, though moderate, is less
desirable, hence the need for stakeholders in TB control to intensify efforts in identifying and
developing solutions. The poor knowledge identified in this study, as a barrier to higher cure
rates among patients, could be modified by health education intervention. Variation in health
centre treatment outcomes underscore the need for further research to identify centre-specific
factors associated with poor treatment outcome.
