A review of the rehabilitation of malnourished tuberculosis adult patients using ready to use therapeutic food in Hoima and Mbale Districts: a retrospective cohort study

Abstract

Introduction Tuberculosis (TB) has existed for millennia and remains a major global health problem causing ill health for about 10 million people each year. For a long period of time, TB was the leading cause of death among infectious diseases until the outbreak of Covid 19 in 2020. TB has been associated with undernutrition and poor treatment outcomes are reported among malnourished patients. Ready to Use Therapeutic Food (RUTF) is used in the rehabilitation of undernourished TB patients. Methods. The study employed both quantitative and qualitative methods for data collection. The quantitative aspect involved a retrospective cohort review of TB patients' records in Hoima and Mbale Regional Referral Hospitals from January 2013 to December 2018. This retrospective cohort study specifically assessed the records of 82 malnourished TB patients treated at these hospitals during the mentioned timeframe. The study evaluated nutrition treatment outcomes, focusing on body mass index (BMI) and mid-upper arm circumference (MUAC) over the four-month rehabilitation period, while also gathering data on TB treatment outcomes such as cured, completed treatment, lost to follow up, died, transferred out, and failed treatment, using a structured data extraction sheet. Data collected were entered into SPSS version 16 for univariate analysis and Stata version 15 for bivariate analysis, conducted at a 95% confidence interval. In-depth interviews with both former and current patients to explore their experiences during nutrition rehabilitation with Ready-to-Use Therapeutic Food (RUTF) were done. Key informant interviews with health workers were carried out to acquire insights into service provide perspectives regarding the use of RUTF in the rehabilitation of malnourished TB adult clients. Translated transcripts from the interviews were analyzed using thematic analysis methodologies, identifying pertinent quotations that emphasized specific behaviors within the report. Results Findings showed 49 patients (59.8%) completed the 4 months of RUTF rehabilitation and average BMI improved significantly from 15.3Kg/m2 to 16.9Kg/m2 (P<0.05) in the four months of nutrition rehabilitation. 10 patients (20.4%) attained normal BMI at 4 months and Patients’ BMI increased exponentially more in the first two months than the last two months of treatment. 65 patients (79%) were followed up for the 6 months of therapy and 22(27%) attained successful treatment outcomes (cured and completed treatment). Patients that had a BMI>17Kg/m2 at 4 months were more likely to attain successful TB treatment outcomes compared to those with a BMI < 17Kg/m2 (OR 7.7, 95%CI: 1.85-32.75, P=0.03: cRR 0.53, 95%CI (0.0339-0.832), p 0.006). Age, sex, length of stay on RUTF and change in BMI had no association with the TB treatment outcomes. Similarly, the risk of having unsuccessful PTB outcome was 24% higher in patients who had been on RUTF for < 4 months compared to those who have been on RUTF for ≥ 4 months. This comparison was not statistically significant, cRR=1.24, 95%CI (0.954-1.622), p 0.106. Patients received diverse nutrition services during rehabilitation including RUTF, therapeutic milk and counselling services. Conclusion and recommendations: Use of RUTF contributes to improvement in the nutrition status among malnourished TB adults and successful TB treatment outcomes. The program can be supported by increasing the RUTF supplies, using the lower level heath system structure to follow up clients and sensitization of community on the uses of RUTF.