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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Tuberculosis treatment outcomes Socio-economic factors Determinants of health Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/0b89bfc8fba94e9cbc9165a052498fc2
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spelling	oai:doaj.org-article:0b89bfc8fba94e9cbc9165a052498fc22021-11-28T12:12:38ZImpact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study10.1186/s12889-021-12056-11471-2458https://doaj.org/article/0b89bfc8fba94e9cbc9165a052498fc22021-11-01T00:00:00Zhttps://doi.org/10.1186/s12889-021-12056-1https://doaj.org/toc/1471-2458Abstract 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.Jasper NidoiWinters MuttambaSimon WalusimbiJoseph F. ImokoPeter LochoroJerry IcthoLevicatus MugenyiRogers SekibiraStavia TuryahabweRaymond ByaruhangaGiovanni PutotoSimone VillaMario C. RaviglioneBruce KirengaBMCarticleTuberculosis treatment outcomesSocio-economic factorsDeterminants of healthPublic aspects of medicineRA1-1270ENBMC Public Health, Vol 21, Iss 1, Pp 1-16 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tuberculosis treatment outcomes Socio-economic factors Determinants of health Public aspects of medicine RA1-1270
spellingShingle	Tuberculosis treatment outcomes Socio-economic factors Determinants of health Public aspects of medicine RA1-1270 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
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.
format	article
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
title	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_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_sort	impact of socio-economic factors on tuberculosis treatment outcomes in north-eastern uganda: a mixed methods study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0b89bfc8fba94e9cbc9165a052498fc2
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Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study

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