DETERMINANTS OF POOR TREATMENT OUTCOME AMONG TUBERCULOSIS PATIENTS IN KILIFI COUNTY, KENYA: RETROSPECTIVE STUDY

Abstract

In 2013, an estimated 9 million people developed TB and 1.5 million died from the disease. Many countries globally have adopted DOT strategy which addresses factors of poor treatment outcome at community and health facility level. Efforts to improve poor tuberculosis treatment outcomes are important aspects in evaluating the effectiveness of tuberculosis control program. The objective of this study defined determinants of poor outcomes and the associated factors for these outcomes in a cohort of patients treated for TB in the County of Kilifi in Kenya. The study was a retrospective analysis of routine programmatic data previously entered in an electronic TB data system called TIBU. Data for a cohort of patients treated for tuberculosis was obtained from all treatment centers in the seven Sub Counties. Patients were categorized as having successful treatment outcome if they were cured, had negative smear microscopy at the end of treatment and at least one follow-up test or if they had completed treatment. Poor treatment outcome is categorized as those with; failed treatment, remained smear-positive after 5 months while on treatment or had defaulted or died during treatment course. Of the 4,772 patients with all forms of TB registered in Kilifi County between January 2012 and December 2013, 625 (13%) had a poor treatment outcome including death 219/625 (35%), treatment interruption or default 257/625 (41%) and failure 23/625 (3%). The risk factors found to be associated with poor outcomes were male gender, HIV-positive and the sub-county of diagnosis. Males had 38% higher risk compared to females, HIV-positives had 59% higher risk compared to HIV-negatives, and TB patients diagnosed at Kilifi County Hospital had in average 11% higher risk. The study revealed that poor treatment outcome is associated with being male, HIV positive, being diagnosed with TB in the Kilifi County hospital and high rates of mortality. Strengthening strategies which target the risk groups including, those at a high mortality, among TB patients may improve treatment outcomes within Kilifi, Kenya.