Factors associated with poor treatment outcomes among tuberculosis patients in Kyangwali Refugee Settlement, Uganda, 2016-2017

Joyce Nguna; Denis Okethwangu; Steven Ndugwa Kabwama; Dativa Maria Aliddeki; Susan Kizito Kironde; Doreen Birungi; Daniel Eurien; Alex Riolexus Ario; Deus Lukoye; Julius Kasozi; Peter J Cegielski

doi:10.1371/journal.pgph.0000152

Factors associated with poor treatment outcomes among tuberculosis patients in Kyangwali Refugee Settlement, Uganda, 2016-2017

PLOS Glob Public Health. 2022 Aug 2;2(8):e0000152. doi: 10.1371/journal.pgph.0000152. eCollection 2022.

Affiliations

¹ Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda.
² Ministry of Health, Kampala, Uganda.
³ United Nations High Commission for Refugees, Kampala, Uganda.
⁴ Division of Global HIV and TB, Global TB Branch, US Centers for Diseases Control and Prevention, Atlanta, Georgia, United States of America.

Abstract

Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies including refugee settings. Tuberculosis and HIV/AIDS are increasingly becoming an important cause of morbidity and mortality in refugee settings. We described the treatment outcomes of TB patients and explored factors associated with treatment outcomes among TB patients attending two facilities in Kyangwali Refugee Settlement in Kikuube District, 2016-2017. We abstracted data on laboratory-confirmed patient data from TB registers from 2016 to 2017, in Kikuube Health Centre IV and Rwenyawawa Health Centre II, both located in Kyangwali Refugee Settlement. We abstracted data on socio-demographic variables including age and sex. Other variables were height, weight, final treatment outcomes, demographics, HIV status, TB treatment category, and history of TB. Treatment outcomes were categorized into favorable (including patients who were cured or those who completed treatment) and unfavorable (those in whom treatment failed, those who died, those lost to follow-up, or those not evaluated). We used logistic regression to identify factors associated with unfavorable treatment outcomes. We identified a total of 254 TB patients with a median age of 36 (IQR 26-48) years; 69% (175) were male and 54% (137) were refugees. The median weight was 50.4 kg (range 4-198). Overall, 139 (55%) had favorable outcomes while 115 (45%) had unfavorable outcomes. Refugees formed 53% (71) of those with favorable outcomes and 47% (63) of those with unfavorable outcomes 63(47%). We found that increasing age was statistically associated with unfavorable outcomes, while diagnosis with MDR-TB was associated with decreased odds for unfavorable treatment outcomes. The treatment success rate was lower compared to 85% recommended by WHO. However, the rates are similar to that reported by other studies in Uganda. Innovative approaches to improve treatment success rates with particular focus on persons aged 41-80 years should be devised.

Copyright: © 2022 Nguna et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This investigation was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through US Centers for Disease Control and Prevention (CDC) under the terms of Cooperative Agreement number GH001353–01, awarded to Makerere University School of Public Health to support the Uganda Public Health Fellowship Program, Ministry of Health. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the funding agencies or Makerere University School of Public Health, and the Ministry of Health of Uganda. Since this was an operational research with a request from the Ugandan Ministry of health, informed consent from patients was not necessary. We collected anonymized data though. We did not receive any special grant for the work, but the work was conducted as an operational research with the Ministry of health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.