The study was conducted in three peripheral health facilities; Mekelle, Semen and Kasech Health Centers of Mekelle, in Northern Ethiopia. The study area is located 783 kms to the North of the capital city of Ethiopia, Addis Ababa. The total population of Mekelle has been estimated to be around 216,000 in 2007 . Selected health facilities were the biggest facilities in terms of TB care and treatment provision with highest patient flow and were located in the relatively high performer zone with regard to TB case detection . Based on the TB clinics’ registration log books, on average 230, 300 and 160 patients per year were estimated to be receiving TB treatments in Mekelle, Semen and Kassech Health Centers, respectively.
Study design and data collection procedure
The study design was a register based retrospective case series analyses on patients of all TB forms who received TB therapy between July 2009 and July 2014. A structured data extraction form was prepared and used to collect information on socio-demographic characteristics (such as age and sex) and clinical-related data (such as, TB history, TB type, date starting treatment, HIV status, date end of treatment and treatment outcome). The data source was the TB registers at the TB clinics of the health facilities, where all patients diagnosed for active TB disease are put on anti-TB treatment and monitored throughout the treatment course. The inclusion criteria were having a complete and readable record in the TB registration book and patients that were diagnosed as non TB after starting of treatment were excluded from the study.
Treatment outcome was defined according to the existing WHO definitions at the time of data collection . Accordingly, components were defined as follows: cured- pulmonary TB patient with smear or culture negative in the last month of treatment and at least one previous occasion. Treatment completed - A TB patient who completed treatment without evidence of failure but with no record to show that sputum smear or culture results in the last month of treatment and on at least one previous occasion were negative, either because tests were not done or because results are unavailable. Treatment failed- is a TB patient whose sputum smear or culture is positive at month 5 or later during treatment. Died – is defined as TB patient who dies for any reason before starting or during the course of treatment. Lost to follow up- A TB patient who did not start treatment or whose treatment was interrupted for 2 consecutive months or more. Not evaluated- A TB patient for whom no treatment outcome is assigned. This includes cases “transferred out” to another treatment unit as well as cases for whom the treatment outcome is unknown to the reporting unit. Treatment success- was defined as the sum of cured and treatment completed. In this study the findings of transferred out patients were not included as one of the TB treatment outcomes.
SPSS version 22 for Windows was used for data analysis. Descriptive statistics were used to summarize patients, characteristics across the outcomes variables. Trend analysis was performed using the percentages of successful treatment outcomes. Moreover, percentage changes in outcome indicators for five years period was analysed. Trend p-value less than 0.05 were considered as statistically significant.