| Summary: | 碩士 === 國立陽明大學 === 國際衛生碩士學位學程 === 106 === Background: Drug resistant tuberculosis (DR-TB) is a critical threat to public health in Swaziland. Despite efforts that the Government of Swaziland has put towards the management of this disease, treatment outcomes for DR-TB patients remain poor. The study aimed to investigate predicting factors of treatment outcomes among DR-TB patients in Swaziland.
Methods: A retrospective cohort design was adopted where secondary review of medical records of all adult patients who initiated DR-TB treatment in Swaziland between January 2013 and December 2014 was done. A total of 800 DR-TB patients’ records were included in the analysis. X2 test was used to determine association among variables. Multinomial logistic regression analysis was used to identify predictors of DR-TB treatment outcomes. Data with P-value <0.05 or equivalent was considered significant.
Results: Of the 800 patients, 419 (52.4%) were cured, 157 (19.6%) completed treatment, 149 (18.6%) died, 52 (6.5%) were lost to follow up (LTFU) and 23 (2.9%) failed treatment. Predictors of mortality after adjustment were: age 40 years and older (OR 2.105, P=0.001); age 15-24 years (OR 1.968, P=0.050); rural residence (OR 1.720, P=0.035); Rifampicin mono resistance (OR 3.822, P=0.002); Rifampicin and Isoniazid resistance only (OR 3.088, P=0.035); non-DOT (OR 2.352, P=0.053); non-provision of food and transport support (OR 2.041, P=0.022). Predictor of LTFU was non-provision of food and transport support during treatment (OR 11.372, P=<0.001). Predictor for treatment success was being located in the Shiselweni region (OR 4.85, P=0.009).
Conclusion: This study revealed high burden of DR-TB accompanied with high mortality which was mostly related to the patient’s demographic, clinical and social support characteristics. Intensification of interventions targeted at early diagnosis and treatment as well as addressing social risks factors that hinder adherence to treatment is necessary to improve DR-TB treatment outcomes in Swaziland.
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