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A MULTIVARIATE ANALYSIS OF RISK FACTORS
ASSOCIATED WITH LOST-TO-FOLLOW-UP ON
TREATMENT AMONG TB PATIENTS IN MULAGO
NATIONAL REFERRAL HOSPITAL,
KAMPALA , UGANDA
Abdikadir Isse Abdi
2020-01-01111
supervised by
Prof. Onuorah Martins
Background of the Study
 The WHO estimates that 10 million people suffered from
TB in 2019, which is equivalent to 130 cases per 100,000
population (WHO, 2020).
 Out of these estimates, 44% of cases occurred in South-
east Asia, 25% in Africa, 18% in the western Pacific, 8.2%
in Eastern Mediterranean, 2.9% in America and 2.5% in
Europe (WHO 2020).
 Sub-Saharan Africa has the highest observed-to expected
ratio of TB incidence and is therefore unlikely to achieve
the sustainable development goal of ending the TB
epidemic by 2035.
Cont…
 In Uganda, the estimated incidence rate for TB was 200
per 100,000 population and the mortality rate was 35 per
100,000 population (WHO, 2020).
 Loss to follow up treatment is defined as a TB patient
whose treatment was interrupted for 2 consecutive
months or more (WHO, 2013).
Statement of the problem
 Uganda is one of the 30 WHO-designated countries
with a high burden of TB (WHO, 2020).
 TB treatment coverage in Uganda has been persistently
low in 2018 (only 65%)
 TB mortalities and infections in Kampala are on rise
and this is shown by increased number of the patients.
 A recent studies in Uganda revealed high rate of LTFU
among TB patients. Thus this study will investigate the
risk factors associated with LTFU among TB patients in
Uganda.
Objectives of the study
 To determine whether the socio-demographics of a
patient is a risk factor associated with lost-to-follow-up
on TB treatment in Mulago TB treatment center.
 To analyze whether Directly Observed Treatment,
Short-Course (DOTS) programme is a risk factor
associated with lost-to-follow-up on TB treatment in
Mulago TB treatment center.
 To ascertain whether patient behavior is a risk factor
associated with lost-to-follow-up on TB treatment in
Mulago TB treatment center.
Methodology
 Study Design: This is a retrospective cohort study which
will be based on record review of patients enrolled in
first-line TB treatment under DOTS program from
January 2021 to January 2022 at Mulago TB treatment
center.
 Study Population: All TB patients who were placed under
DOTS program and started TB treatment from January
2021 to January 2022 at Mulago TB treatment center.
 Data Collection:
Demographic and clinical information of TB patients
admitted between January 2021 to January 2022 at Mulago
TB treatment center will be extracted from the DOTS TB
register of Mulago TB treatment center. The study will
exclude all TB patients with poor treatment outcome other
than LTFU, (i.e. died, transferred out, and treatment
failure).
 Analysis:
Bivariate analysis using Chi-squared test or crude odds
ratios will be used to identify factors associated with
LTFU.
Significant factors will be subsequently included in the
multivariate logistic regression analysis to adjust odds
ratios for confounding for independent predictors for
LTFU and to elaborate on the relationships between
multiple variables.
References
 Harichander, S., Wiafe, E., Mensah, K. B., Bangalee, V., & Oosthuizen, F. (2022). The incidence of TB and MDR-TB in pediatrics
and therapeutic options: a systematic review. Systematic reviews, 11(1), 1-15.
 Kibuule, D., Aiases, P., Ruswa, N., et al. (2019). Predictors of loss to follow-up of tuberculosis cases under the DOTS programme
in Namibia. ERJ Open Res 2020; 6: 00030-2019. https://doi.org/10.1183/23120541.00030-2019.
 Kyu, H.H., Maddison, E.R., Henry, N.J., Ledesma, J.R., Wiens, K.E., Reiner, R., et al. (2018). Global, regional, and national burden
of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study. Lancet Infect Dis
2018; 18(12):1329–49 Dec 1.
 Martin, M. K., Paul, O. J., Sara, R., Hilary, A., Frank, M., Augustin, M. K., ... & Gladys, T. (2021). High rates of culture conversion
and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda. BMC Infectious
Diseases, 21(1), 1-9.
 World Health Organization (2013). Definitions and Reporting Framework for Tuberculosis—2013,World Health Organization,
2013.
 World Health Organization (2019). Global Tuberculosis Report. Geneva: World Health Organization, 2019. License: CCBY-NC-
SA3.0IGO.
 World Health Organization (2019). WHO consolidated guidelines on drug-resistant tuberculosis treatment (No.
WHO/CDS/TB/2019.7). World Health Organization.
 World Health Organization (2020). Global tuberculosis report 2020.
 Zawedde-Muyanja, S., Katamba, A., Cattamanchi, A., Castelnuovo, B., & Manabe, Y. C. (2020). Patient and health system factors
associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in
Uganda. BMC public health, 20(1), 1-8.

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TOPIC - ABDIKADIR ISSE ABDI (2020-01-01111).pptx

  • 1. A MULTIVARIATE ANALYSIS OF RISK FACTORS ASSOCIATED WITH LOST-TO-FOLLOW-UP ON TREATMENT AMONG TB PATIENTS IN MULAGO NATIONAL REFERRAL HOSPITAL, KAMPALA , UGANDA Abdikadir Isse Abdi 2020-01-01111 supervised by Prof. Onuorah Martins
  • 2. Background of the Study  The WHO estimates that 10 million people suffered from TB in 2019, which is equivalent to 130 cases per 100,000 population (WHO, 2020).  Out of these estimates, 44% of cases occurred in South- east Asia, 25% in Africa, 18% in the western Pacific, 8.2% in Eastern Mediterranean, 2.9% in America and 2.5% in Europe (WHO 2020).  Sub-Saharan Africa has the highest observed-to expected ratio of TB incidence and is therefore unlikely to achieve the sustainable development goal of ending the TB epidemic by 2035.
  • 3. Cont…  In Uganda, the estimated incidence rate for TB was 200 per 100,000 population and the mortality rate was 35 per 100,000 population (WHO, 2020).  Loss to follow up treatment is defined as a TB patient whose treatment was interrupted for 2 consecutive months or more (WHO, 2013).
  • 4. Statement of the problem  Uganda is one of the 30 WHO-designated countries with a high burden of TB (WHO, 2020).  TB treatment coverage in Uganda has been persistently low in 2018 (only 65%)  TB mortalities and infections in Kampala are on rise and this is shown by increased number of the patients.  A recent studies in Uganda revealed high rate of LTFU among TB patients. Thus this study will investigate the risk factors associated with LTFU among TB patients in Uganda.
  • 5. Objectives of the study  To determine whether the socio-demographics of a patient is a risk factor associated with lost-to-follow-up on TB treatment in Mulago TB treatment center.  To analyze whether Directly Observed Treatment, Short-Course (DOTS) programme is a risk factor associated with lost-to-follow-up on TB treatment in Mulago TB treatment center.  To ascertain whether patient behavior is a risk factor associated with lost-to-follow-up on TB treatment in Mulago TB treatment center.
  • 6. Methodology  Study Design: This is a retrospective cohort study which will be based on record review of patients enrolled in first-line TB treatment under DOTS program from January 2021 to January 2022 at Mulago TB treatment center.  Study Population: All TB patients who were placed under DOTS program and started TB treatment from January 2021 to January 2022 at Mulago TB treatment center.
  • 7.  Data Collection: Demographic and clinical information of TB patients admitted between January 2021 to January 2022 at Mulago TB treatment center will be extracted from the DOTS TB register of Mulago TB treatment center. The study will exclude all TB patients with poor treatment outcome other than LTFU, (i.e. died, transferred out, and treatment failure).
  • 8.  Analysis: Bivariate analysis using Chi-squared test or crude odds ratios will be used to identify factors associated with LTFU. Significant factors will be subsequently included in the multivariate logistic regression analysis to adjust odds ratios for confounding for independent predictors for LTFU and to elaborate on the relationships between multiple variables.
  • 9. References  Harichander, S., Wiafe, E., Mensah, K. B., Bangalee, V., & Oosthuizen, F. (2022). The incidence of TB and MDR-TB in pediatrics and therapeutic options: a systematic review. Systematic reviews, 11(1), 1-15.  Kibuule, D., Aiases, P., Ruswa, N., et al. (2019). Predictors of loss to follow-up of tuberculosis cases under the DOTS programme in Namibia. ERJ Open Res 2020; 6: 00030-2019. https://doi.org/10.1183/23120541.00030-2019.  Kyu, H.H., Maddison, E.R., Henry, N.J., Ledesma, J.R., Wiens, K.E., Reiner, R., et al. (2018). Global, regional, and national burden of tuberculosis, 1990–2016: results from the Global Burden of Diseases, Injuries, and Risk Factors 2016 Study. Lancet Infect Dis 2018; 18(12):1329–49 Dec 1.  Martin, M. K., Paul, O. J., Sara, R., Hilary, A., Frank, M., Augustin, M. K., ... & Gladys, T. (2021). High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda. BMC Infectious Diseases, 21(1), 1-9.  World Health Organization (2013). Definitions and Reporting Framework for Tuberculosis—2013,World Health Organization, 2013.  World Health Organization (2019). Global Tuberculosis Report. Geneva: World Health Organization, 2019. License: CCBY-NC- SA3.0IGO.  World Health Organization (2019). WHO consolidated guidelines on drug-resistant tuberculosis treatment (No. WHO/CDS/TB/2019.7). World Health Organization.  World Health Organization (2020). Global tuberculosis report 2020.  Zawedde-Muyanja, S., Katamba, A., Cattamanchi, A., Castelnuovo, B., & Manabe, Y. C. (2020). Patient and health system factors associated with pretreatment loss to follow up among patients diagnosed with tuberculosis using Xpert® MTB/RIF testing in Uganda. BMC public health, 20(1), 1-8.