Risk factors for the occurrence of multidrug-resistant tuberculosis among patients undergoing multidrug-resistant tuberculosis treatment in East Shoa, Ethiopia.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is resistant to the two main first-line anti-tuberculosis drugs: rifampicin and isoniazid. It is a major threat to public health worldwide. The objective of this study was to assess the potential risk factors for multidrug-resistant tuberculosis among patients undergoing MDR-TB treatment at two community hospitals in Ethiopia. METHODS: A case-control study design was conducted from February 1, 2016, to April 29, 2016. TB-positive patients with MDR-TB and non-MDR-TB were considered as cases and controls, respectively. A total of 219 study participants were included in the study. An interviewer-administered structured questionnaire was used to collect primary data from the patients, and a checklist was used to collect data from the clinical records. Bivariate and multivariate logistic regression analyses were used to assess the potential risk factors for the occurrence of MDR-TB. RESULTS: The odds of developing MDR-TB were higher in patients previously treated with anti-TB drugs (odds ratio [OR] = 6.1, 95%CI: 2.92-12.62, P < 0.001), those with a history of contact with known TB patients (OR = 2.1, 95%CI: 1.04-4.43, P < 0.001), those living in a rural setting (OR = 5.6, 95%CI: 2.14-14.46, P = 0.001), those with a history of alcohol consumption (OR = 4.3, 95%CI: 2.29-10.49, P < 0.001) and those without a job (OR = 2.4, 95%CI: 1.06-5.42, P = 0.001). CONCLUSIONS: The study revealed that contact with known TB patients, previous TB treatment, residence area, lack of a job, and alcohol consumption were potential risk factors for the occurrence of MDR-TB. Enhancing public health education, intensifying directly observed therapy programmes for all TB patients and designing control strategies are recommended.

Predictors of loss to follow-up in antiretroviral treatment for adult patients in the Oromia region, Ethiopia.

PURPOSE: It is known that antiretroviral treatment (ART) reduces mortality from acquired immunodeficiency syndrome related causes. Patient's lost to follow-up (LTFU) in this treatment poses a paramount problem to the public and health care services. Information on predictors of loss to follow-up is scarce in this study area and similar settings. Therefore, this study aimed at identifying correlates of loss to follow-up in ART among adult patients in the Oromia region of Ethiopia. METHODS: A case-control study was conducted between February 2015 and April 2015 using medical records. The stratified sampling technique was used to select health facilities. The number of patient records to be included in the study was proportionally allocated to each stratum based on their patient proportion in the regional data. Specific health facilities from which to include the records were randomly selected from a list of the health facilities per stratum. All adult patient records registered as LTFU (416) in the selected health facilities during the 12-month period prior to the data collection date, and 832 patients with good adherence to ART were included. Data were double-entered into Epi Info 7 and analyzed using SPSS 20. Descriptive statistics and binary logistic regression were used to report the results. Qualitative data were thematically analyzed using open code computer software. RESULTS: Age 15-24 years (adjusted odds ratio [AOR], 19.82 95% CI: 6.80, 57.73); day laborers (AOR, 5.36; 95% confidence interval [CI]: 3.23, 8.89), rural residents (AOR, 2.35; 95% CI: 1.45, 3.89), World Health Organization clinical stage IV (AOR, 2.29; 95% CI: 1.45, 3.62), baseline CD4 <350 cells/mL (AOR, 2.06; 95% CI: 1.36, 3.13), suboptimal adherence to ART (AOR, 7.42; 95% CI: 1.87, 29.41), were factors which increased the risk of loss to follow-up in ART. CONCLUSION: Multiple risk factors, both socioeconomic and clinical, were associated with loss to follow-up. Attention is required to address these factors during patient preparation for the treatment and follow-up counseling by practitioners. We recommend that other studies identify what happened to the patients registered as LTFU as the current study could not address this issue.