Predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia

Autoři: Demelash Woldeyohannes aff001;  Tesfaye Assefa aff002;  Rameto Aman aff001;  Yohannes Tekalegn aff001;  Zeleke Hailemariam aff003
Působiště autorů: Department of Public Health, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia aff001;  Department of Nursing, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia aff002;  Department of Public Health, Collage of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224025



Multidrug-resistant tuberculosis (MDR-TB) is a man-made problem when bacteria are resistant to at least two anti TB drugs (Rifampicin and Isoniazid). Currently from tuberculosis infected patients, two out of ten are developing MDR-TB and it is an emerging public health problem in Ethiopia. Despite high burden of MDR-TB in Ethiopia, the treatment outcomes and predictors related to incidence among MDR-TB patients is not studied in Oromia region, Ethiopia. Therefore, the present study assessed the predictors of time to unfavorable treatment outcomes among patients with multidrug resistant tuberculosis in Oromia region, Ethiopia


Facility based retrospective cohort study was conducted at hospitals in Oromia Region. All registered MDR-TB patient charts from 2015 to 2017 were considered for the study. Data entry was done by using EPI data version 3.1 Statistical Software and data analysis was done by SPSS version 20. The descriptive statistics, frequency, median and range were employed. Bivariate and multivariate Cox proportional hazard regression analysis was used to identify predictors of time to unfavorable treatment outcomes of multidrug resistant tuberculosis. In multivariate Cox proportional hazard regression analysis, the variables with P- value less than and equal to 0.05 were considered as predictor variables for time to unfavorable treatment outcome of MDR-TB.


From the total of 415 (92.84%) complete MDR-TB charts, the overall cumulative probability of unfavorable treatment outcome at the end of the treatment (two years) was 21.21%. In multivariate Cox proportional hazard analysis initial culture result [AHR = 0.52; 95% CI: 0.29, 0.96], HIV test result [AHR = 3.76; 95% CI: 2.45, 5.78] and culture at the end of continuation phases [AHR = 0.12; 95% CI: 0.08, 0.20] were the predictors of unfavorable treatment outcome.


The magnitude of unfavorable treatment outcome at Oromia hospitals was lower than WHO regional report of 2018. This finding demonstrated that low unfavorable treatment outcomes for MDR-TB patients can be achieved in a resource-constrained and high TB-burden setting. Whereas, Initial culture result, HIV test result and culture at the end of continuation phases were determined as predictor factors with associated unfavorable treatment outcomes. Culture positive and HIV positive MDR-TB patients need special attention at the time of treatment.

Klíčová slova:

Data processing – Drug therapy – Ethiopia – Extensively drug-resistant tuberculosis – HIV – Charts – Multi-drug-resistant tuberculosis – Tuberculosis


1. Organization WHO(2009) Global tuberculosis control: epidemiology, strategy, financing: WHO report 2009: World Health Organization.

2. Dheda K, Gumbo T, Maartens G, Dooley KE, McNerney R(2017) The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. The lancet Respiratory medicine 5: 291–360.

3. Organization WHO (2013) Global tuberculosis report 2013: World Health Organization.

4. Sharma SK, Mohan A (2006) Multidrug-resistant tuberculosis: a menace that threatens to destabilize tuberculosis control. Chest 130: 261–272. doi: 10.1378/chest.130.1.261 16840411

5. Organization WHO (2017) Critically important antimicrobials for human medicine: ranking of antimicrobial agents for risk management of antimicrobial resistance due to non-human use.

6. Organization WHO (2011) Towards universal access to diagnosis and treatment of multidrug-resistant and extensively drug-resistant tuberculosis by 2015: WHO progress report 2011.

7. Organization WHO (2008) Global tuberculosis control: surveillance, planning, financing: WHO report 2008: World Health Organization.

8. Organization WHO (2016) Global tuberculosis report 2016: World Health Organization.

9. Federal Ministry of Health of Ethiopia (FMOH). Tuberculosis Prevention and Control Programme: special issue for world TB day. 2011. 3:17–37.

10. Federal Ministry of Health of Ethiopia (FMOH). Guideline for program and clinical management of drug resistant tuberculosis. Addis Ababa: FMOH; 2009.

11. Alene KA, Yi H, Viney K, McBryde ES, Yang K(2017) Treatment outcomes of patients with multidrug-resistant and extensively drug resistant tuberculosis in Hunan Province, China. BMC infectious diseases 17: 573. doi: 10.1186/s12879-017-2662-8 28814276

12. Girum T, Tariku Y, Dessu S (2017) Survival Status and Treatment Outcome of Multidrug Resistant Tuberculosis (MDR-TB) among Patients Treated in Treatment Initiation Centers (TIC) in South Ethiopia: A Retrospective Cohort Study. Annals of Medical and Health Sciences Research 7.

13. Getachew T, Bayray A, Weldearegay B (2013) Survival and Predictors of Mortality among Patients under multi-drug resistant tuberculosis treatment in Ethiopia: st. Peter's specialized tuberculosis hospital, Ethiopia. International Journal of Pharmaceutical Sciences and Research 4: 776.

14. Meressa D, Hurtado RM, Andrews JR, Diro E, Abato K(2015) Achieving high treatment success for multidrug-resistant TB in Africa: initiation and scale-up of MDR TB care in Ethiopia—an observational cohort study. Thorax: thoraxjnl-2015-207374.

15. Gadallah MA, Mokhtar A, Rady M, El-Moghazy E, Fawzy M(2016) Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt. Journal of the Formosan Medical Association 115: 997–1003. doi: 10.1016/j.jfma.2015.10.002 26696497

16. Patel SV, Nimavat KB, Alpesh PB, Shukla LK, Shringarpure KS(2016) Treatment outcome among cases of multidrug-resistant tuberculosis (MDR TB) in Western India: A prospective study. Journal of infection and public health 9: 478–484. doi: 10.1016/j.jiph.2015.11.011 26724262

17. Helbling P, Altpeter E, Egger J-M, Zellweger J-P (2014) Treatment outcomes of multidrug-resistant tuberculosis in Switzerland. Swiss Med Wkly 144: w14053. doi: 10.4414/smw.2014.14053 25474040

18. Anderson L, Tamne S, Watson J, Cohen T, Mitnick C(2013) Treatment outcome of multi-drug resistant tuberculosis in the United Kingdom: retrospective-prospective cohort study from 2004 to 2007. Eurosurveillance 18: 20601. doi: 10.2807/1560-7917.es2013.18.40.20601 24128699

19. Marks SM, Flood J, Seaworth B, Hirsch-Moverman Y, Armstrong L(2014) Treatment practices, outcomes, and costs of multidrug-resistant and extensively drug-resistant tuberculosis, United States, 2005–2007. Emerging infectious diseases 20: 812. doi: 10.3201/eid2005.131037 24751166

20. Alene KA, Viney K, McBryde ES, Tsegaye AT, Clements AC (2017) Treatment outcomes in patients with multidrug‐resistant tuberculosis in north‐west Ethiopia. Tropical Medicine & International Health 22: 351–362.

21. Tupasi TE, Garfin AMCG, Kurbatova EV, Mangan JM, Orillaza-Chi R(2016) Factors associated with loss to follow-up during treatment for multidrug-resistant tuberculosis, the Philippines, 2012–2014. Emerging infectious diseases 22: 491. doi: 10.3201/eid2203.151788 26889786

22. Tola HH, Shojaeizadeh D, Garmaroudi G, Tol A, Yekaninejad MS (2015) Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia. Global health action 8: 29019. doi: 10.3402/gha.v8.29019 26610316

23. Gandhi NR, Andrews JR, Brust J, Montreuil R, Weissman D (2012) Risk factors for mortality among MDR-and XDR-TB patients in a high HIV prevalence setting. The International Journal of Tuberculosis and Lung Disease 16: 90–97. doi: 10.5588/ijtld.11.0153 22236852

24. Kurbatova EV, Taylor A, Gammino VM, Bayona J, Becerra M (2012) Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects. Tuberculosis 92: 397–403. doi: 10.1016/ 22789497

25. Organization WH (2004) Anti-tuberculosis drug resistance in the world: third global report.

26. Migliori GB, Dheda K, Centis R, Mwaba P, Bates M (2010) Review of multidrug‐resistant and extensively drug‐resistant TB: global perspectives with a focus on sub‐Saharan Africa. Tropical Medicine & International Health 15: 1052–1066.

27. Günther G, Van Leth F, Altet N, Dedicoat M, Duarte R (2015) Beyond multidrug-resistant tuberculosis in Europe: a TBNET study. The International Journal of Tuberculosis and Lung Disease 19: 1524–1527. doi: 10.5588/ijtld.15.0274 26614196

Článek vyšel v časopise


2019 Číslo 10