Factors associated with unfavourable tuberculosis treatment outcomes in Lusaka, Zambia, 2015: a secondary analysis of routine surveillance data.

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Nanzaluka, Francis H.
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The University of Zambia
Tuberculosis (TB) is a major public health challenge in low and middle income countries. Factors associated with unfavourable treatment outcomes have been known to affect treatment and control of the disease. However, analysis of routine data in Zambia does not show the factors associated. We determined the proportion of tuberculosis treatment outcomes and factors associated. Unfavourable outcome was defined as death, lost-to-follow-up, treatment-failure, or not-evaluated, and favourable outcome as a patient cured or completed-treatment. Data were abstracted from treatment registers at a referral hospital, an urban-clinic and peri-urban (purposively selected) for all TB cases on treatment from 1st January to 31st December, 2015. Proportions were calculated for treatment outcomes, and associations between unfavourable outcome and factors including age, HIV status, health facility, and patient type, were analysed using univariate logistics regression. Multivariable stepwise logistic regression was used to control for confounding, report adjusted odds ratios (AOR), and 95% confidence intervals (CI). A total of 1724 registered TB patients from the urban-clinic (40%), 1st Level Hospital (38%) and peri-urban-clinic (22%) were included in the study. Of the total patients overall unfavourable outcome was 43%. Total unfavourable outcome was treatment-failure (0.3%), lost-to-follow-up (5%), death (9%) and not-evaluated (29%). The odds of unfavourable outcome were higher among patients >59 years (AOR=2.9, 95%CI:1.44–5.79), among relapses (AOR=1.65, 95%CI:1.15–2.38), patients who sought treatment at the Urban clinic (AOR=1.76, 95%CI:1.27–2.42) and among TB/HIV co-infected patients (AOR=1.56, 95%CI:1.11–2.19). The overall unfavourable treatment outcome found in the study was high in the selected facilities. Being >59years old, being a relapse case, being HIV positive and seeking treatment at the urban clinic were factors found to be associated with unfavourable treatment outcomes. Special attention to patients of >59years old, relapse cases and HIV positive in the TB treatment is recommended and also close monitoring of health facilities in increasing efforts aimed at evaluating all the outcomes. Studies are required to identify and test interventions aimed at improving treatment outcomes.
Thesis of Master of Science in Epidemiology.