Advances in Pharmacoepidemiology and Drug Safety

Abstract

Assessment of the Survival Status and Risk Factors for the Mortality among Multidrug Resistant Tuberculosis Patients at Adama and Bishoftu General Hospitals, Oromia, Ethiopia: A Retrospective Cohort Study

Debalke Fantaw, Mamo Feyissa, Shifa Hamid and Workineh Shibeshi

Background: Multi-drug resistant tuberculosis is a widespread global problem. The magnitude of this disease varies significantly from country to country and the treatment outcomes are inadequately described in Ethiopia.

Objective: To assess the survival status and risk factors for mortality of multidrug resistant tuberculosis patients at Adama and Bishoftu General Hospitals in Ethiopia. Methods: Retrospective cohort study design was conducted among multidrug resistant tuberculosis patients treated from May, 2013 to August, 2017 at Adama and Bishoftu General Hospitals. Data were collected using standardized data abstraction format. Data were analysed using STATA Version 13 statistical software. Risks were estimated for the entire follow-up time corresponding to each event occurrence using Kaplan-Meier method and the covariates were fitted to Cox Proportional Hazard Regression Model.

Result: Among 164 patients, 74 (45.10%) were male and the mean age was 31.5 years. The participants were followed for a total of 63,141 person-days. The median survival time was 400.5 days. There were 30 (18.30%) known deaths and the survival probability of the study participants at 6, 12, 18 and 24 months of treatment was 84%, 82%, 81% and 72%, respectively. The Cox regression analysis showed that factors independently associated with mortality of patients were: HIV (AHR=2.75, 95% CI(1.23- 6.15); low initial body weight(HR=0.44,95% CI (0.22-0.85); co-morbidities and co-infections (AHR=2.28, 95% CI (1.99- 5.26); age (AHR=2.26 ,95% CI (1.35-3.79); and Khat use (AHR=0.41, 95% CI (0.18-0.97).

Conclusion: A lower survival time was found with declining probability of survival across duration of treatment. Higher mortality rate was noted in patients who started MDR-TB treatment with initial low body weight, HIV positive, co-morbidities and co-infections and Khat user.