Factors Associated with Tuberculosis Treatment Outcomes among Patients Attending Treatment Centers in Mogadishu, Somalia

Abstract

Tuberculosis (TB) remains one of the major health problems and the second leading infectious cause of mortality around the world. According to World Health Organization (WHO) 2016 report, TB remained one of the top 10 causes of death worldwide. There were an estimated 1.4 million TB deaths in 2015, and an additional 0.4 million deaths resulting from TB disease among people living with HIV. According to World Bank, the average TB incidence for Somalia from 1990 to 2014 was 284.96 cases per 100,000 people with a minimum of 274 cases per 100,000 people in 2014 and a maximum of 286 cases per 100,000 people in 1990. TB prevalence is 513 per 100,000 population and the mortality rate from TB excluding HIV/TB co-infection has been assessed at 64/100,000. Despite the availability of free TB treatment in TB centers in Somalia, the prevalence rates of TB and MDR-TB still remain high (513 per 100,000 population and 5.2% among new cases and 40.7% among retreatment cases respectively). The objective of this study was to determine factors associated with TB treatment outcomes among patients attending TB treatment centers in Mogadishu. The study adopted a cross-sectional design, using quantitative and qualitative methods of data collection. Data was collected by means of interviewer administered semi-structured questionnaire to ascertain individual and institutional level factors associated with TB treatment outcomes and key in-depth interviews with health workers to obtain more information on TB treatment and outcomes. Qualitative information was analyzed thematically using NVIVO 8. Quantitative data was analyzed using SPSS version 20. Descriptive analysis was done using frequencies, proportions, percentages and means. Chi-square test was used to establish the association between the dependent and the independent variables. The level of significance was set at 95%. The study findings were presented in form of tables and charts. Results indicated that the proportion of individuals with successful treatment outcomes was 81.8%. Successful treatment outcome was higher in married (p=0.001), educated (p=0.044), HIV-negative (p=0.003), new treatment case (p=0.001), and patients with knowledge on TB (p=0.048). None of the TB-health facility factors influenced TB treatment outcomes (p-value>0.05). The study recommended in depth patient education on TB management and treatment. Moreover, there was need to improve on patient – health provider relationship for increased successful treatment outcomes.