Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study
Abstract Background Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-e...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-021-12056-1 |
| _version_ | 1819014171437563904 |
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| author | Jasper Nidoi Winters Muttamba Simon Walusimbi Joseph F. Imoko Peter Lochoro Jerry Ictho Levicatus Mugenyi Rogers Sekibira Stavia Turyahabwe Raymond Byaruhanga Giovanni Putoto Simone Villa Mario C. Raviglione Bruce Kirenga |
| author_facet | Jasper Nidoi Winters Muttamba Simon Walusimbi Joseph F. Imoko Peter Lochoro Jerry Ictho Levicatus Mugenyi Rogers Sekibira Stavia Turyahabwe Raymond Byaruhanga Giovanni Putoto Simone Villa Mario C. Raviglione Bruce Kirenga |
| author_sort | Jasper Nidoi |
| collection | DOAJ |
| description | Abstract Background Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. Methods We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. Results A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18–0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18–18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11–6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. Conclusions This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care. |
| first_indexed | 2024-12-21T02:11:36Z |
| format | Article |
| id | doaj.art-0b89bfc8fba94e9cbc9165a052498fc2 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-21T02:11:36Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-0b89bfc8fba94e9cbc9165a052498fc22022-12-21T19:19:21ZengBMCBMC Public Health1471-24582021-11-0121111610.1186/s12889-021-12056-1Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods studyJasper Nidoi0Winters Muttamba1Simon Walusimbi2Joseph F. Imoko3Peter Lochoro4Jerry Ictho5Levicatus Mugenyi6Rogers Sekibira7Stavia Turyahabwe8Raymond Byaruhanga9Giovanni Putoto10Simone Villa11Mario C. Raviglione12Bruce Kirenga13Makerere University Lung Institute (MLI)Makerere University Lung Institute (MLI)Makerere University Lung Institute (MLI)Makerere University Lung Institute (MLI)Doctors with Africa CUAMMDoctors with Africa CUAMMMakerere University Lung Institute (MLI)Makerere University Lung Institute (MLI)National Tuberculosis and Leprosy Control Program (NTLP)National Tuberculosis and Leprosy Control Program (NTLP)Doctors with Africa CUAMMCentre for Multidisciplinary Research in Health Science, University of MilanCentre for Multidisciplinary Research in Health Science, University of MilanMakerere University Lung Institute (MLI)Abstract Background Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. Methods We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. Results A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18–0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18–18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11–6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. Conclusions This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.https://doi.org/10.1186/s12889-021-12056-1Tuberculosis treatment outcomesSocio-economic factorsDeterminants of health |
| spellingShingle | Jasper Nidoi Winters Muttamba Simon Walusimbi Joseph F. Imoko Peter Lochoro Jerry Ictho Levicatus Mugenyi Rogers Sekibira Stavia Turyahabwe Raymond Byaruhanga Giovanni Putoto Simone Villa Mario C. Raviglione Bruce Kirenga Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study BMC Public Health Tuberculosis treatment outcomes Socio-economic factors Determinants of health |
| title | Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study |
| title_full | Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study |
| title_fullStr | Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study |
| title_full_unstemmed | Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study |
| title_short | Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study |
| title_sort | impact of socio economic factors on tuberculosis treatment outcomes in north eastern uganda a mixed methods study |
| topic | Tuberculosis treatment outcomes Socio-economic factors Determinants of health |
| url | https://doi.org/10.1186/s12889-021-12056-1 |
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