Factors associated with the therapeutic outcomes of tuberculous patients in the city of Antananarivo

Context: Unfavourable therapeutic
outcomes are frequent situations that condition the effectiveness of tuberculosis
(TB) control in Madagascar. Treatment failure and abandonment exposes to
clinical complications and death. They perpetuate the spread of the disease and
the development of drug resistance.

Objective: The objective of this
study is to determine factors associated with the therapeutic outcomes of TB.

Methods: A retrospective cohort
study of TB patients diagnosed and treated from January 1 to December 31, 2018,
was conducted at the TB Diagnostic and Treatment Center of Analakely Hospital
(CHUSSPA). Univariate and multivariate logistic regression was used to
establish the relationship between dependent and independent variables.

Results: The study enrolled 628
patients with a mean age of 37.19 with a standard deviation of 15.86 years. The
sex ratio of males to females was estimated to be 1.57. The treatment success
rate is estimated at 82.3% and the death rate at 4.9%. The failure and drop-out
rates are estimated at 0.2 per cent and 8.3 per cent respectively. The
determinant of success was represented by female gender (AOR 1.67 [1.07-2.66];
p=0.026). The smear negative pulmonary TB (SMEAR-) is an unfavourable factor
for treatment success (AOR 0.38 [0.23-0.65]; p<0.001). The discontinuation
factor was represented by the SNPTB clinical form (AOR 3.17 [1.60-6.21];
p=0.001). The SNPTB clinical form (AOR=8.03 [3.01-23.72]; p<0.001]) and the
extra-pulmonary form (EPTB) with an AOR 5.15 [1.99-14.95]; p=0.001 are found as
a factor in the occurrence of deaths.

Conclusion: Reinforcement of the diagnostic strategy for MPT patients - and of the
therapeutic education of male and MPT patients - and rigorous monitoring of EPTB
forms are essential to reduce the occurrence of these unfavourable outcomes.