G Katana1,3 ,C Obonyo1, S Deche1, J Chakaya2, A Willet 3, OA
Abdullahi3, PJ Hassanali3
INSTITUTIONs:
1.
2.
3.
Ministry of Health , Kilifi County Department of Health
The Nairobi Hospital College of Health Sciences
Pwani University
Background
 Tuberculosis (TB) is a curable disease
 Globally 8 million cases
 1.87 million deaths due to:
▪ Noncompliance to treatment
▪ Late diagnosis
Kilifi TB Outcomes 2012 –
Kenya NTLD annual Report
Type of TSR
TB
PTB+
86.7%
Failure
OOC
Death
TO
0.2%
7%
2.7%
3.5%
Cases
(n)
848
Relapse 70%
+
PTB90.5%
0%
20%
5%
5%
20
0%
2.8%
4.1%
2.7%
904
EPTB
88%
0%
4.5%
5.6%
1.5%
269
SMND
91.9%
0%
3.9%
3.6%
0.6%
334
TSR-treatment success rate, OOC=out of control, TO=transfer out,
SMND=smear not done.
TIBU – DHIS-2012
Supervision
and Data
Collection
MDR
Patient
Mpesa
Support
Logistics
&
EQA
Commodi
ties
Cohort
reports
Problem statement
 Poor treatment outcomes despite recent strategies
 Current focus not targeting factors associated with
poor outcome
 TB Mortality rates increasing in Kilifi
Justification
 50%-80% of patients die, if untreated
 TB Poor treatment outcomes have not been
studied in Kilifi County.
 Understanding risk factors for poor treatment
outcome could assist TB programme to target
interventions
Specific Objectives
1. To determine the demographic characteristics
2. To describe the outcomes according to TB type
& category.
3. To describe risk factors associated with poor
treatment outcomes among TB patients.
Methods: Study site
Kilifi Population: 1.2 million
Conceptual framework
Category of
patients: New,
Relapse, Defaulter
and Failure
Socio-demographic
factors: age, sex,
and residence
Treatment outcome
Success: Cure ,Treatment Complete
Type of TB:
Pulmonary/Extra
pulmonary
HIV status:
Positive/Negative
Methods: Design
 Study design: Retrospective cohort analysis
 Data source: TIBU surveillance data base
 Study population: TB patients (from 0 to 65+years)
 Main Outcome: Poor treatment outcome
Analyses: Logistic regression using R
 Inclusion criteria: patients on anti TB therapy- 2012-2013
 Exclusion criteria: TB patients transferred out
Results: Age characteristics(N=4,772)
Category of TB patient
HIV Status of TB patients
Treatment Outcome
4.6%
Poor Outcome:10.75% N=499
*Transfer out not included, n=126(2.6%)
Predictors for Poor Outcome
FACTOR
OR
P- VALUE C.I.
Age
0.998
0.957
0.943-1.056
Male
1.383
0.000
1.157-1.652
HIV status
1.586
0.000
1.352-1.859
Kilifi County
Hospital
0.887
0.000
0.847-0.938
•
•
•
•
Male gender, HIV-status, the sub County of diagnosis
Males had 38% higher risk compared to females,
HIV-positives had 59% higher risk compared to HIV-negatives,
Diagnosed at Kilifi County Hospital had in average 11% higher
Discussion
 Male sex was associated with poor
outcome
 TB strategies could improve treatment
outcomes by targeting:
• men, young adults, HIV+ve, Kilifi County
Hospital
 Results confirm the trend that mortality is
increasing (from 2.7% in 2012; 4.6% in
2012,2013) Despite use of TIBU model
Recommendations
•
Identify targeted interventions for people
with risk factors for poor treatment outcome
including: men, young adults, the elderly,
HIV +ve, treated at KCH
 Strengthen TB supportive supervision to all
treatment centres, especially in KCH