Analysis of the factors that influence outcome of tuberculosis treatment using first line drugs in Uganda - Case study: Mbarara University Teaching Hospital and Mulago Hospital
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The increase in lack of adherence to tuberculosis treatment has been attributed to patients’ failure to complete treatment whereby they expose themselves to the risk of reactivation of the disease and on the other hand health services have failed to evaluate treatment outcome because they lose contact with the patients before completion of treatment. This study aimed at analyzing the factors that influence treatment outcome after 8 months of short course chemotherapy. Data were summarized using frequency tables, the chi-square test was used to test for independence and binary regression was used to determine the factors that influence treatment outcome after 8 months of treatment. The study involved patients who were treated at Mulago and Mbarara University teaching hospitals under the Directly Observed Treatment short course (DOTS) and followed up for a period of 8 months for the year 2003. Data was obtained from hospital records of patients which included variables like age, sex, category of patient, treatment regimen given, category of disease and outcome of treatment (this was noted as cured, not cured, defaulted, referred and died) at the end of the period. The study involved 1437 patients who were treated for over 8 months with initial therapy of 2 months and a continuation phase of 6 months using different treatment regimens. It comprised of 625 females and 812 males of all ages. Of the patients involved, 69.03% tested positive for pulmonary tuberculosis and 30.97% had extra pulmonary tuberculosis. 29.44% of the patients were cured after 8 months of treatment, 20.11% were not cured though they completed treatment, 47.74% defaulted, 0.35% died and 2.37% transferred. Patients of all ages were treated with the youngest patient being one year old and the oldest was 86 years old and on average, patients were 33 years old. The study established that the only factors that influence treatment outcome were, pretreatment status, hospital visited and treatment regimen used in the first 2 months as observed from the complementary log log model. The age of the patient, treatment regimen used for the continuation phase of 6 months and patient category did not influence outcome. Patients that tested positive for pulmonary tuberculosis had a higher chance of getting cured at the end of the 8 months of treatment. From this study, the following recommendations were made, proper record management to assist in the follow up of patients, sensitization of the public concerning the disease and decentralization of health services to reduce on the transport costs.