Malnutrition and unsuccessful tuberculosis treatment among people with multi-drug resistant tuberculosis in Uganda: A retrospective analysis

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Abstract

Rationale

Multi-drug-resistant tuberculosis (MDR-TB) poses a significant public health challenge to the control and successful eradication of TB globally. Suboptimal treatment outcomes are common among persons with MDR-TB necessitating a need to understand the contextual factors.

Objective

We determined the factors associated with unsuccessful TB treatment among persons with MDR-TB at a large TB Unit in Central Uganda.

Methods

We retrospectively reviewed medical records for all persons with MDR-TB at Mubende Regional Referral Hospital MDR-TB Clinic in Central Uganda. The patients were treated with either second-line, modified second-line, or individualized anti-TB regimens and completed treatment between January 2012 and October 2023. The primary outcome was unsuccessful TB treatment defined as death, treatment failure, or loss to follow-up and measured as a binary outcome. We used a multivariable binary logistic regression analysis to determine the factors independently associated with unsuccessful TB treatment at a 5 % statistical significance level. We reported the adjusted odds ratio (aOR) and the 95 % confidence interval (CI).

Measurements and results

We analyzed data from 98 persons with MDR-TB who were aged 15–78 years (mean 36.4 ± 15.4 years). Of these, 40 (40.8 %) were cured, 25 (25.5 %) completed TB treatment, 1 (1.0 %) had treatment failure, 13 (13.3 %) died, and 19 (19.4 %) were lost to follow-up. Overall, 33 (33.7 %) participants had unsuccessful TB treatment which was associated with older age for a 1-year increase in age (aOR 1.05, 95 % CI 1.01–1.09), malnutrition—mid-upper arm circumference of <12.5 cm (aOR 2.99, 95 % CI 1.16–7.98), and previous TB treatment (aOR 0.28, 95 % CI 0.10–0.77).

Conclusion

Unsuccessful TB treatment is high among persons with MDR-TB at this TB Unit. It is more likely as age advances and when persons with MDR-TB have malnutrition, but less likely when they have been previously treated for TB. Therefore, interventions to improve treatment outcomes may be beneficial for persons with MDR-TB who are older, malnourished, and those newly diagnosed with the disease. For example, routine nutritional assessment and counseling, including nutritional support for malnourished persons with MDR-TB may be needed to optimize their TB treatment success.

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乌干达耐多药结核病患者的营养不良与结核病治疗失败:回顾性分析
理由耐多药结核病(MDR-TB)对全球控制和成功根除结核病构成了重大的公共卫生挑战。在 MDR-TB 患者中,治疗效果不理想的情况很常见,因此有必要了解其背景因素。方法我们回顾性地查阅了乌干达中部穆本德地区转诊医院 MDR-TB 诊所所有 MDR-TB 患者的医疗记录。这些患者接受了二线、改良二线或个体化抗结核治疗方案,并在 2012 年 1 月至 2023 年 10 月期间完成了治疗。主要结果是结核病治疗失败,定义为死亡、治疗失败或失去随访,以二元结果衡量。我们使用多变量二元逻辑回归分析来确定与结核病治疗不成功独立相关的因素,统计显著性水平为 5%。我们报告了调整后的几率比(aOR)和 95 % 的置信区间(CI)。其中,40 人(40.8%)治愈,25 人(25.5%)完成结核病治疗,1 人(1.0%)治疗失败,13 人(13.3%)死亡,19 人(19.4%)失去随访。总体而言,有 33 人(33.7%)的结核病治疗未获成功,而年龄每增加 1 岁就会增加(aOR 1.05,95 % CI 1.01-1.09),营养不良-中上臂围为 12.5 厘米(aOR 2.99,95 % CI 1.16-7.98),以及以前接受过结核病治疗(aOR 0.28,95 % CI 0.10-0.77)。随着年龄的增长和 MDR-TB 患者营养不良,治疗不成功的可能性更大,但如果他们以前接受过结核病治疗,则可能性较小。因此,对于年龄较大、营养不良和新确诊的 MDR-TB 患者来说,改善治疗效果的干预措施可能对他们有益。例如,可能需要进行常规营养评估和咨询,包括为营养不良的 MDR-TB 患者提供营养支持,以优化他们的结核病治疗效果。
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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
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