Treatment outcome of tuberculosis patients at Debretabor General Hospital, Amhara, Northwest Ethiopia

A retrospective study was carried out between December 2016 to December 2018 from TB patients attending the health institutions of Debretabor General Hospital. All tuberculosis cases reported between 2016-2018 were reviewed carefully and analyzed. A total of 455 Tb patients were enrolled in this study and data were coded and entered in to the computer for statistical analysis using SPSS version 20 and Epi-info soft wares.

The treatment success rate of tuberculosis patients was satisfactory 89.7%. In the study, There are strategies to reduce the diseases burden, early detection of the cases and treatment are the main means for controlling and prevention of the cases( 4 ). WHO introduced the DOTs (Directly Observed treatment short course) strategy as one of the tools for prevention and control mechanism of TB( region. Currently the program is provided almost in all health institutions In Ethiopia, still the prevalence and incidence of tuberculosis is the highest burden even if the expansion of the DOTS (Directly Observed treatment short course) program is during the past decades. In Ethiopia, for long time direct microscopy of sputum-smear method is the main means to diagnose TB for both new and follow up cases (

).
Even though there is a wide coverage of the DOTs program and other controlling and prevention programs of TB in the study area, still the information related with the treatment outcomes of Tb patients is little. In this study, we assessed the treatment outcomes of TB patients in Debre Tabor General Hospital, Amhara region, Ethiopia

Study area
The study was conducted in Debrtabor town, Amhara region, Northern Ethiopia. Debre Tabor is the town of south Gondar, located in Northern-west from Addis Ababa (capital city of Ethiopia

Operational definition Extra pulmonary tuberculosis(EPTB)
It refers TB that involves organs other than the lung. e.g. pleura, lymph nodes, abdomen, genitourinary tract, skin, joints, bones and meninges. Diagnosis should be based on at least one specimen with confirmed Mtb or histological or strong clinical evidence consistent with active EPTB, followed by a decision of a clinician to treat with a full course of tuberculosis chemotherapy.

Pulmonary tuberculosis(PTB)
It refers to a case of TB involving the lung parenchyma and can be classified as:-Pulmonary TB, smear positive (SPPTB):SPPTB case is based on the presence of at least one acid fast bacillus (AFB+) in at least one sputum sample in countries with a wellfunctioning EQA system. In countries without functional EQA, a SPPTB case is defined as one with two or more initial sputum smear examinations positive for AFB, or one sputum smear examination positive for AFB plus radiographic abnormalities consistent with active PTB as determined by a clinician or one sputum smear positive for AFB plus sputum culture-positive for Mtb.
Pulmonary TB, smear-negative(SNPTB):a case of PTB is considered to be smear-negative if at least two sputum specimens at the start of treatment are negative for AFB in countries with a functional EQA system, where the workload is very high and human resources are    53-19.70)).Being urban dweller also 4.16 times higher TB treatment success rate than the counterpart (AOR=4.16, 95%CI :( 1.89-9.11)).TB/HIV co-infection was also affecting TB treatment success rate. Those participants who had TB/HIV co-infection were found to be poor TB treatment outcome than those who had no HIV co-infection (AOR=0.22, 95%CI :( 0.08-0.60)).The odds of TB treatment success rate was 5.74 times higher among participants who were diagnosed TB for the first time (AOR=5.74, 95%CI :( 2.17-15.22)) compared with counterparts (see table 3).

Discussion
Tuberculosis is still one of the most common public health problem in terms of morbidity and mortality in Ethiopia though governmental and non-governmental institutions try to introduce different ways of strategies to reduces the disease burden (   7  ). Our study found that TB treatment succeeds rate of tuberculosis patients at ). This is might be due to the study period, and geographical location.
In ours data review, all TB patients were screened for HIV. Of the total TB patients, 86(18.9%) were HIV/TB confection which is lower than study done in Ethiopia: Amhara 236 This variation might be geographical location, level of awareness and others.

Limitations
In medical records during the review process, we didn't get the full information of sociodemographic and clinical variable.

Conclusion
In our study the outcomes of TB treatment in the DOTS clinic of Debretabor General Hospital showed us age, residence, TB/HIV co-infection status, and categories of TB were found to be significantly associated with TB treatment success rate at 95% confidence interval in the final model. TB/HIV co-infection was also affecting TB treatment success rate. Capacity building of professionals for records and keeping should be increased.