Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study.
Determinants of health
Socio-economic factors
Tuberculosis treatment outcomes
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
26 11 2021
26 11 2021
Historique:
received:
11
05
2021
accepted:
15
10
2021
entrez:
27
11
2021
pubmed:
28
11
2021
medline:
15
12
2021
Statut:
epublish
Résumé
Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
Sections du résumé
BACKGROUND
Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja.
METHODS
We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression.
RESULTS
A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes.
CONCLUSIONS
This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
Identifiants
pubmed: 34836521
doi: 10.1186/s12889-021-12056-1
pii: 10.1186/s12889-021-12056-1
pmc: PMC8620143
doi:
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2167Informations de copyright
© 2021. The Author(s).
Références
J Public Health (Oxf). 2018 Sep 1;40(3):e359-e366
pubmed: 29036661
Lancet Infect Dis. 2018 Mar;18(3):261-284
pubmed: 29223583
J Health Popul Nutr. 2018 Jan 5;37(1):1
pubmed: 29304840
PLoS Med. 2019 Apr 30;16(4):e1002788
pubmed: 31039158
PLoS One. 2020 Jan 15;15(1):e0227293
pubmed: 31940375
Lancet Glob Health. 2017 Sep;5(9):e924-e935
pubmed: 28807190
Cad Saude Publica. 2018 Feb 05;34(1):e00153116
pubmed: 29412320
PLoS Med. 2014 Jul 15;11(7):e1001675
pubmed: 25025331
PLoS One. 2013;8(2):e56248
pubmed: 23457534
Int J Tuberc Lung Dis. 2012 Jun;16(6):733-9
pubmed: 22410546
Clin Infect Dis. 2012 Oct;55(8):1154-63
pubmed: 22820541
Lancet Infect Dis. 2014 Nov;14(11):1105-1112
pubmed: 25303845
Int J Tuberc Lung Dis. 2017 Sep 1;21(9):957-964
pubmed: 28826444
Int J Tuberc Lung Dis. 2006 Oct;10(10):1104-10
pubmed: 17044202
BMC Public Health. 2017 Sep 19;17(1):725
pubmed: 28927386
Int J Tuberc Lung Dis. 1999 Jul;3(7):596-602
pubmed: 10423222
BMC Infect Dis. 2019 May 28;19(1):474
pubmed: 31138129
BMC Public Health. 2007 Feb 08;7:19
pubmed: 17288593
BMC Infect Dis. 2015 Nov 19;15:536
pubmed: 26584607
AIDS Behav. 2014 Oct;18 Suppl 5:S542-53
pubmed: 24710958
Lancet Infect Dis. 2016 Apr;16(4):473-9
pubmed: 26725446
Int J Tuberc Lung Dis. 2014 Jan;18(1):44-8
pubmed: 24365551
Int J Tuberc Lung Dis. 2017 May 1;21(5):564-570
pubmed: 28399972
Int J Equity Health. 2018 Jan 8;17(1):4
pubmed: 29310659
Tuberculosis (Edinb). 2017 Mar;103:44-51
pubmed: 28237033
Trans R Soc Trop Med Hyg. 2016 Mar;110(3):148-50
pubmed: 26884490
Pulmonology. 2018 Mar - Apr;24(2):115-119
pubmed: 29275968
J Natl Med Assoc. 2007 Sep;99(9):1013-23
pubmed: 17913111
Lancet Glob Health. 2018 May;6(5):e514-e522
pubmed: 29580761
Epidemiol Infect. 2019 Jan;147:e71
pubmed: 30869023
Int J Tuberc Lung Dis. 2011 Jun;15 Suppl 2:37-49
pubmed: 21740658
Bull World Health Organ. 2007 Sep;85(9):703-11
pubmed: 18026627
Trials. 2013 May 28;14:154
pubmed: 23714270
Glob Public Health. 2020 Jun;15(6):877-888
pubmed: 32027555
F1000Res. 2017 Oct 23;6:1873
pubmed: 31839924
J Infect Public Health. 2020 Aug;13(8):1148-1155
pubmed: 32295755
PLoS One. 2018 Mar 19;13(3):e0194675
pubmed: 29554144
JAMA. 2005 Dec 14;294(22):2879-88
pubmed: 16352796
Clin Infect Dis. 2019 Jun 18;69(1):159-166
pubmed: 30383204
Trans R Soc Trop Med Hyg. 2016 Mar;110(3):145-7
pubmed: 26884489
BMC Public Health. 2020 Sep 16;20(1):1409
pubmed: 32938411
Clin Med (Lond). 2016 Dec;16(Suppl 6):s79-s91
pubmed: 27956446
J Clin Tuberc Other Mycobact Dis. 2018 Jul 03;12:41-47
pubmed: 31720398
Int J Environ Res Public Health. 2018 Dec 05;15(12):
pubmed: 30563175
Am J Public Health. 2011 Apr;101(4):654-62
pubmed: 21330583
BMC Public Health. 2018 Jun 26;18(1):795
pubmed: 29940908
BMC Health Serv Res. 2019 Apr 3;19(1):213
pubmed: 30943967
Soc Sci Med. 2009 Jun;68(12):2240-6
pubmed: 19394122
Am J Prev Med. 2007 Sep;33(3):250-64
pubmed: 17826585
BMC Infect Dis. 2016 May 20;16:214
pubmed: 27198545
Eur J Public Health. 2015 Dec;25(6):951-60
pubmed: 26089181