Adverse Treatment Outcomes among Tuberculosis Patients Enrolled under Directly Observed Treatment Strategy in Murang'a County

Abstract

Despite global advances in Tuberculosis control, it remains one of the biggest threat, accounting for 10 million cases and 1.4 million deaths yearly. In Murang'a County, TB is 8th among causes of death and 12.5% of the patients end up with adverse treatment outcomes. The study aimed to determine the adverse treatment outcomes and associated factors among tuberculosis patients in Murang'a County. It was a retrospective study in which secondary quantitative epidemiological data extracted from health records of patients registered between 2017 and 2019 and primary qualitative data gathered through a focus group discussion were analysed. Descriptive proportions were calculated and a computer package (SPSS 24) used for univariate and multivariable analysis to describe relationships between independent and dependent variables. Adverse outcomes occurred in 7.54% of the patients which included death (6.43%), treatment failure (0.72%) and conversion to multidrug resistance (0.39%). Factors found to influence adverse treatment outcomes were; old age, male gender, under-weight, immune depression, unknown and negative mycobacterial test results, attitude towards anti-TB therapy, alcohol and drug abuse, social stigma, drug and staff shortage, distant treatment centers and poverty. The study concluded that 7.54 of the TB patients in Murang’a County have adverse treatment outcomes, and that there are demographic, clinical, patient, community level and health system related factors associated with them. Public education and social welfare programmes including counselling and financial support should be provided especially to the elderly, male, undernourished and immune depressed TB patients. Gender imbalances disadvantaging men as a result of alcohol and drug abuse, lack of family support during TB disease, and poor health seeking behavior among should be addressed. The Government should provide close treatment centers, employ more staff and ensure consistent supply of anti-TB drugs, while health care workers should ensure strict case management and good patient-health care worker relationship.