Factors Associated with Tuberculosis Treatment Outcomes among Patients in Mombasa County

Abstract

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which is an air born disease transmitted from person to person by aerosolized droplet nuclei. It typically affects the lungs (pulmonary tuberculosis) but can affect other sites as well. The failure to eliminate or completely reduce TB as a public health problem has been largely associated with little attention the disease attracts from the government, poor management of TB control programmes, high rates of poverty and population growth especially in urban areas due to migration and HIV/AIDS pandemic. Considerable progress has been made since introduction of DOTS strategy. The primary objective of this study was to determine the factors associated with TB outcomes among TB patients in Mombasa County. The study was conducted in Mombasa County which is one of the 47 counties in Kenya with an urban population of 1,063,854. The study was conducted in all health care units in the county. The study used a cross-sectional research design. The study population was the total number of notified patients with tuberculosis in one quarter in the study area (Mombasa’s health care units) and this was found to be 1207 in the year 2017. It was from this population that a systematic random sample size of 265 patients were interviewed. Data was collected within a period of three months with the help of three research assistants using semi-structured questionnaire and focused group discussion guide Quantitative data were analyzed using SPSS version 20 Descriptive statistics frequency (%), mean, and standard deviation were used to express quantitative data. In bivariate analyses, odds ratios (OR) and 95% confidence intervals (CI) for the association between TB treatment outcome and health related factors, institutional factors and patient related factors was done using logistic regression. The results revealed that patients who are educated about health are more likely to cure of TB than patients who are not (OR 1.716, 95% CI, 0.35 to 2.48). More so, patients who receive psychosocial support are more likely to get cured than those who don’t receive psychosocial support (OR 4.08, 95% CI, 2.00 to 8.32). The results also revealed that patients who visits hospitals where health-workers are trained in less than 6 months are more likely to get cured compared to those who visits hospitals where health workers last training was more than a year (OR - 3.116, 95% CI, 0.703 to 3.93). The results further reveal that monthly supervision is more likely to result to cure as compared to no supervision at all (OR 2.433, 95% CI, 0.72 to 4.142). Similarly, once in a while supervision is more likely result to cure as compared to no supervision at all (OR 1.432, 95% CI, 0.31 to 3.12). The results of the study give evidence to, therefore, conclude patient related factors, health care workers related factors, and institutional factors are critical to TB treatment outcome in that order. The study gives an impetus to propose categorical efforts in addressing patient related factors such as enhancing further awareness on treatment adherence and imposition of penalties to habitual treatment defaulters. Institutional frameworks also need to be put in place to address distance to health centre issues, convenience of clinic time and drug stock out as a sure way of minimizing the sources of variation on TB treatment outcome.