Treatment outcome of new smear positive pulmonary tuberculosis patients in Penang, Malaysia

BMC Infectious Diseases

Zaheer-Ud-Din Babar⁶  Muhammad Asif¹  Irfhan Ali³  Asrul Akmal Shafie⁵  Syed Azhar Syed Sulaiman²  Muhammad Atif⁴ 

[1] Department of Pharmacology, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia;Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia;Respiratory Department, Penang General Hospital, Penang, Malaysia;Department of Pharmacy, The Islamia University of Bahawalpur, Punjab, Pakistan;Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia;Division of Pharmacy Practice, School of Pharmacy, University of Auckland, Auckland, New Zealand

关键词: Malaysia;    Penang;    Tuberculosis treatment duration;    Unsuccessful treatment outcome;    Treatment outcomes;    Smear positive pulmonary tuberculosis;   

Others  :  1127329
DOI  :  10.1186/1471-2334-14-399

 received in 2013-07-19, accepted in 2014-07-11,  发布年份 2014

【 摘 要 】

Background

According to the World Health Organization’s recent report, in Malaysia, tuberculosis (TB) treatment success rate for new smear positive pulmonary tuberculosis (PTB) patients is still below the global success target of 85%. In this study, we evaluated TB treatment outcome among new smear positive PTB patients, and identified the predictors of unsuccessful treatment outcome and longer duration of treatment (i.e., > 6 months).

Methods

The population in this study consisted of all new smear positive PTB patients who were diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. During the study period, a standardized data collection form was used to obtain socio-demographic, clinical and treatment related data of the patients from their medical charts and TB notification forms (Tuberculosis Information System; TBIS). These data sources were reviewed at the time of the diagnosis of the patients and then at the subsequent follow-up visits until their final treatment outcomes were available. The treatment outcomes of the patients were reported in line with six outcome categories recommended by World Health Organization. Multiple logistic regression analysis was used to find the independent risk factors for unsuccessful treatment outcome and longer treatment duration. Data were analyzed using the PASW (Predictive Analysis SoftWare, version 19.0. Armonk, NY: IBM Corp).

Results

Among the 336 PTB patients (236 male and 100 female) notified during the study period, the treatment success rate was 67.26% (n = 226). Out of 110 patients in unsuccessful outcome category, 30 defaulted from the treatment, 59 died and 21 were transferred to other health care facilities. The mean duration of TB treatment was 8.19 (SD 1.65) months. In multiple logistic regression analysis, risk factors for unsuccessful treatment outcome were foreign nationality, male gender and being illiterate. Similarly, risk factors for mortality due to TB included high-grade sputum and presence of lung cavities at the start of treatment, being alcoholic and elderly. Likewise, concurrent diabetes, presence of lung cavities at the start of the treatment and being a smoker were the significant predictors of longer treatment duration.

Conclusion

Our findings indicated that the treatment success rate among the new smear positive PTB patients was less than the success target set by World Health Organization. The proportion of patients in the successful outcome category may be increased by closely monitoring the treatment progress of the patients with aforementioned high risk characteristics. Similarly, more aggressive follow-up of the treatment defaulters and transferred out patients could also improve the TB treatment success rate.

【 授权许可】

   
2014 Atif et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Global tuberculosis report 2013 [http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf webcite]
• [2]Bhunu C, Mushayabasa S, Tchuenche J: A theoretical assessment of the effects of smoking on the transmission dynamics of tuberculosis. Bull Math Biol 2011, 73:1333-1357.
• [3]Treatment of tuberculosis: guidelines [http://whqlibdoc.who.int/publications/2010/9789241547833_eng.pdf webcite]
• [4]Diel R, Niemann S: Outcome of tuberculosis treatment in Hamburg: a survey, 1997-2001. Int J Tuberc Lung Dis 2003, 7:124-131.
• [5]Helbling P, Medinger C, Altpeter E, Raeber PA, Beeli D, Zellweger JP: Outcome of treatment of pulmonary tuberculosis in Switzerland in 1996. Swiss Med Wkly 2002, 132:517-522.
• [6]Abdullah JD, Sulaiman SAS, Ahmed A, Muttalif AR, Qais AB: Outcomes of tuberculosis treatment: a retrospective cohort analysis of smoking versus non-smoking patients in Penang, Malaysia. J Public Health 2011, 19:183-189.
• [7]Nik NR, Mohd NS, Wan M, Sharina D, Nik RN: Factors associated with unsuccessful treatment outcome of pulmonary tuberculosis in Kota Bharu, Kelantan. Malays J Publ Health Med 2011, 11:6-15.
• [8]Ismail I, Bulgiba A: Determinants of unsuccessful tuberculosis treatment outcomes in Malaysian HIV-infected patients. Prev Med 2013, 57:S27-S30.
• [9]Performance of the department of respiratory from the year 2009 to 2011 [http://hpp.moh.gov.my/v2/ webcite]
• [10]Atif M, Sulaiman SA, Shafie AA, Asif M, Sarfraz MK, Low HC, Babar ZU: Impact of tuberculosis treatment on health-related quality of life of pulmonary tuberculosis patients: a follow-up study. Health Qual Life Outcomes 2014, 12:19. BioMed Central Full Text
• [11]Ditah IC, Reacher M, Palmer C, Watson JM, Innes J, Kruijshaar ME, Luma HN, Abubakar I: Monitoring tuberculosis treatment outcome: analysis of national surveillance data from a clinical perspective. Thorax 2008, 63:440-446.
• [12]Centers for Disease Control and Prevention: Treatment of tuberculosis. Morb Mortal Wkly Rep 2003, 52:1-77.
• [13]Gopi PG, Chandrasekaran V, Subramani R, Santha T, Thomas A, Selvakumar N, Narayanan PR: Association of conversion & cure with initial smear grading among new smear positive pulmonary tuberculosis patients treated with Category I regimen. Indian J Med Res 2006, 123:807-814.
• [14]Singla R, Osman MM, Khan N, Al-Sharif N, Al-Sayegh MO, Shaikh MA: Factors predicting persistent sputum smear positivity among pulmonary tuberculosis patients 2 months after treatment. Int J Tuberc Lung Dis 2003, 7:58-64.
• [15]Farah MG, Tverdal A, Steen TW, Heldal E, Brantsaeter AB, Bjune G: Treatment outcome of new culture positive pulmonary tuberculosis in Norway. BMC Public Health 2005, 5:14. BioMed Central Full Text
• [16]Kherad O, Herrmann FR, Zellweger JP, Rochat T, Janssens JP: Clinical presentation, demographics and outcome of Tuberculosis (TB) in a low incidence area: a 4-year study in Geneva, Switzerland. BMC Infect Dis 2009, 9:217. BioMed Central Full Text
• [17]Solliman MA, Hassali MA, Al-Haddad MS, Sulaiman SAS, Atif M, Saleem F: Treatment outcomes of new smear positive pulmonary tuberculosis patients in north east Libya. Lat Am J Pharm 2012, 31:567-573.
• [18]Atif M, Sulaiman SAS, Shafie AA, Ali I, Hassali MA, Saleem F: WHO guidelines for treatment of tuberculosis: the missing links. Int J Clin Pharm 2012, 34:506-509.
• [19]Rieder HL, Lauritsen JM, Naranbat N, Katamba A, Laticevschi D, Mabaera B: Quantitative differences in sputum smear microscopy results for acid-fast bacilli by age and sex in four countries. Int J Tuberc Lung Dis 2009, 13:1393-1398.
• [20]Malaysia: the mellinumum development goals at 2010 [http://www.undp.org.my/files/editor_files/files/Malaysia%20MDGs%20report%20clean%200419.pdf webcite]
• [21]Borgdorff MW, Veen J, Kalisvaart NA, Broekmans JF, Nagelkerke NJ: Defaulting from tuberculosis treatment in the Netherlands: rates, risk factors and trend in the period 1993-1997. Eur Respir J 2000, 16:209-213.
• [22]Yone EWP, Kuaban C, Kengne AP: HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study. BMC Infect Dis 2012, 12:190. BioMed Central Full Text
• [23]Horne DJ, Hubbard R, Narita M, Exarchos A, Park DR, Goss CH: Factors associated with mortality in patients with tuberculosis. BMC Infect Dis 2010, 10:258. BioMed Central Full Text
• [24]Nguyen LT, Hamilton CD, Xia Q, Stout JE: Mortality before or during treatment among tuberculosis patients in North Carolina. Int J Tuberc Lung Dis 2011, 15:257-262.
• [25]Mathew TA, Ovsyanikova TN, Shin S, Gelmanova I, Balbuena DA, Atwood S, Peremitin GG, Strelis AK, Murray MB: Causes of death during tuberculosis treatment in Tomsk Oblast, Russia. Int J Tuberc Lung Dis 2006, 10:857-863.
• [26]Ormerod LP, Prescott RJ: The management of pulmonary and lymph node tuberculosis notified in England and Wales in 1998. Clin Med 2003, 3:57-61.
• [27]Chee CBE, Wang YT, Teleman MD, Boudville IC, Chew SK: Treatment outcome of Singapore residents with pulmonary tuberculosis in the first year after introduction of a computerised treatment surveillance module. Singapore Med J 2006, 47:529-533.
• [28]Antoine D, French CE, Jones J, Watson JM: Tuberculosis treatment outcome monitoring in England, Wales and Northern Ireland for cases reported in 2001. J Epidemiol Community Health 2007, 61:302-307.
• [29]Liam CK, Lim KH, Wong CMM, Tang BG: Attitudes and knowledge of newly diagnosed tuberculosis patients regarding the disease, and factors affecting treatment compliance. Int J Tuberc Lung Dis 1999, 3:300-309.
• [30]Talay F, Kumbetli S, Altin S: Factors associated with treatment success for tuberculosis patients: a single center’s experience in Turkey. Jpn J Infect Dis 2008, 61:25-30.
• [31]Bao QS, Du YH, Lu CY: Treatment outcome of new pulmonary tuberculosis in Guangzhou, China 1993–2002: a register-based cohort study. BMC Public Health 2007, 7:344. BioMed Central Full Text
• [32]Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W: Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg 2009, 80:634-639.
• [33]Atif M, Sulaiman SAS, Shafie AA, Muttalif A, Hassali M, Saleem F: Health-related quality of life (HRQoL) in co-morbid tuberculosis relapse patient: a case report from Malaysia. Trop J Pharmaceut Res 2012, 11:651-655.