| dc.description.abstract | The WHO’s 194 Member States endorsed the End TB strategy during the 2014 World Health
Assembly for the period 2016–2035. To achieve the targets starting 2020, the Directly Observed
Treatment Short course (DOTS) intervention has been intensified globally. With the TB regimen
it is perceived that the TB DOTS intervention/strategy can augment treatment completion and cure
rates among patients. However to date there have been variations in the effects and achievements
of the DOTS strategy between countries, yet more than 187 countries have implemented DOTS.
Tuberculosis (TB) is still one of the top 10 causes of death worldwide, with increments in each
year. In Uganda where both facility-based and CBDOTs are available, TB prevalence stands at
253 per 100,000 people, compared to 159 per 100,000 in 2015, with over 1700 MDR-TB cases
registered. Mpigi, is no different, although the DOTS has been implemented in the district, more
than 1000 cases of TB are detected annually with loss to follow up rates exceeding 20%. This calls
for the evaluation of the strategy and the establishment of what predicts treatment outcomes among
beneficiaries.The purpose of this study was to assess treatment outcomes and their predictors
among tuberculosis patients in the directly observed treatment short course intervention of Mpigi
district.
The study was conducted in Mpigi district using a retrospective chart review (RCR) design, among
Tuberculosis patients who had been receiving treatment in the TB DOTS intervention of Mpigi
district in the year 2016 and 2017. The sample size was determined using a formula by Yamane
(1967). Mpigi district was selected because it is representative of rural Uganda (NPHC 2014);
public health facilities were targeted and randomly sampled using simple random sampling
technique. Data was collected using data abstraction method, and captured using the data
abstraction form. Statistical analysis was performed using SPSS version 20, in which descriptive
statistics were done, and Fishers exact test, Chi Square tests and the binary logistic regression was
done to analyze relationships between variables.
The majority of the TB patients, whose records were sampled, had successful treatment outcomes
83% (208/250) while 17% (42/250) had unsuccessful treatment. The individual predictors of
successful treatment outcomes among patients under DOTs include; Patient Smear at 2nd month
of follow up (AOR = 3.373, CI = 1.811 - 5.253) and Patient Smear at 5th month of follow up (AOR
= 8.820, CI = 3.215 - 10.115). While only the type of DOTs the patient was treated under (AOR
= 7.181, CI = 2.952 - 9.136) was predictive of treatment outcomes among the DOTS strategy
related characteristics.
Between the years 2016 and 2017, the DOTS intervention/strategy had substantial effect on the
treatment outcomes of patients who were treated under it; about 8 of every 10 patients who were
treated under DOTS had successful treatment outcomes. The treatment outcomes of patients under
DOTS are predicted by majorly individual patient characteristics and to a relatively smaller extent
by intervention characteristics. Treatment outcomes among patients on DOTs can be further
improved by augmenting counseling in case of positive smear at 2nd month, and putting emphasis
on the CBDOTS arm of the DOTs intervention. The study could not assess treatment outcomes of
those patients who could have been diagnosed alternatively e.g. using Urine TB LAM as these
were not available in the context of Mpigi during the period of the study. Further research is needed
to assess treatment outcomes among patients diagnosed by different diagnostic modalities other
than clinical diagnosis, sputum analysis, Gene expert and Chest X-ray. | en_US |
