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Research article
Desta Kassa
Ethiopian Public Health Institute
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0624-8122
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to improve the effectiveness of TB programs. This study aimed to investigate trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia.
Methods: In this retrospective cohort study, demographic and clinical data of all TB cases registered in 25 refugee camps in Ethiopia from January 2014 to December 2017 were extracted. Multivariate logistic regression was fitted to estimate odds ratios and corresponding 95% confidence intervals for the measure of association linked with factors significantly associated with unsuccessful treatment outcomes.
Results: A total of 1553 TB cases, mean age 27.7 years, were registered from 2014 to 2017. Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in number of notified TB cases (138 to 588 cases), in percentage of EPTB (23.2% to 32.7%), in contribution of children to total TB cases (18.8% to 30.1%) and to EPTB (40.6% to 65.1%), and in proportion of bacteriologically confirmed new and relapse pulmonary cases (43.8% to 64.8%). Treatment success rates for all TB cases remained lower at 72.7%-79.4%. On average 24.8% had unfavorable treatment outcome, including 11.5% not evaluated, 8.0% LTFU, 4.8% died and 0.5% treatment failed. Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive.
Conclusions: There was continuous increase in notified TB cases and in percentage of childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases increased overtime. TB treatment success remained lower than the national achievement in 2017 (96%) and global target (>=90%), which needs improvement. The higher LTFU, not evaluated, and death suggests the need to strengthen adherence education and supervision. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives.
Keywords
Tuberculosis, refugees, refugee camps, case notification, treatment outcome
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 3
Posted 07 Dec, 2020
No community comments so far
Editorial decision: Accept
On 20 Jan, 2021
Reviewers invited
Invitations sent on 12 Jan, 2021
Editor assigned
On 23 Nov, 2020
Submission checks complete
On 23 Nov, 2020
Editor invited
On 23 Nov, 2020
No comments provided
Editorial decision: Major revision
On 17 Oct, 2020
Editor assigned
On 05 Oct, 2020
Submission checks complete
On 04 Oct, 2020
Editor invited
On 04 Oct, 2020
No comments provided
Review #1 received
Received 22 Sep, 2020
Editorial decision: Major revision
On 22 Sep, 2020
Review #2 received
Received 19 Sep, 2020
Reviewer #2 agreed
On 28 Aug, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Reviewers invited
Invitations sent on 21 Aug, 2020
Editor assigned
On 07 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
First submitted
On 04 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
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A new preprint design is coming!
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See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Desta Kassa
Ethiopian Public Health Institute
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0624-8122
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
Version 3
Posted 07 Dec, 2020
No community comments so far
Editorial decision: Accept
On 20 Jan, 2021
Reviewers invited
Invitations sent on 12 Jan, 2021
Editor assigned
On 23 Nov, 2020
Submission checks complete
On 23 Nov, 2020
Editor invited
On 23 Nov, 2020
No comments provided
Editorial decision: Major revision
On 17 Oct, 2020
Editor assigned
On 05 Oct, 2020
Submission checks complete
On 04 Oct, 2020
Editor invited
On 04 Oct, 2020
No comments provided
Review #1 received
Received 22 Sep, 2020
Editorial decision: Major revision
On 22 Sep, 2020
Review #2 received
Received 19 Sep, 2020
Reviewer #2 agreed
On 28 Aug, 2020
Reviewer #1 agreed
On 27 Aug, 2020
Reviewers invited
Invitations sent on 21 Aug, 2020
Editor assigned
On 07 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
First submitted
On 04 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background: Severity of TB increases in refugee populations. Monitoring TB case notification and treatment outcomes are essential to improve the effectiveness of TB programs. This study aimed to investigate trends in TB case notification and treatment outcomes and explore factors associated with unsuccessful treatment outcome in refugee camps in Ethiopia.
Methods: In this retrospective cohort study, demographic and clinical data of all TB cases registered in 25 refugee camps in Ethiopia from January 2014 to December 2017 were extracted. Multivariate logistic regression was fitted to estimate odds ratios and corresponding 95% confidence intervals for the measure of association linked with factors significantly associated with unsuccessful treatment outcomes.
Results: A total of 1553 TB cases, mean age 27.7 years, were registered from 2014 to 2017. Of these notified cases 54.7% were men, 27.7% children (< 15 years), 71.2% pulmonary TB (PTB), 27.8% Extra-PTB (EPTB) and 98.3% new and relapse. From 2014 to 2017: there was consistent increase in number of notified TB cases (138 to 588 cases), in percentage of EPTB (23.2% to 32.7%), in contribution of children to total TB cases (18.8% to 30.1%) and to EPTB (40.6% to 65.1%), and in proportion of bacteriologically confirmed new and relapse pulmonary cases (43.8% to 64.8%). Treatment success rates for all TB cases remained lower at 72.7%-79.4%. On average 24.8% had unfavorable treatment outcome, including 11.5% not evaluated, 8.0% LTFU, 4.8% died and 0.5% treatment failed. Unsuccessful treatment was significantly associated with pretreatment weight below 40 Kg, age over 45 years, and being HIV positive.
Conclusions: There was continuous increase in notified TB cases and in percentage of childhood TB. Proportion of bacteriologically confirmed new and relapse pulmonary cases increased overtime. TB treatment success remained lower than the national achievement in 2017 (96%) and global target (>=90%), which needs improvement. The higher LTFU, not evaluated, and death suggests the need to strengthen adherence education and supervision. Special socio-economic support and monitoring is required for patients with pretreatment weight below 40 Kg, age over 45 years and HIV positives.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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