Determinants of unsuccessful tuberculosis treatment outcome in Northern Red Sea region, Eritrea.

BACKGROUND: Eritrea has achieved the global target (90%) for tuberculosis (TB) treatment success rate. Though, events of unsuccessful TB treatment outcomes (death, treatment failure, lost to follow up and not evaluated) could lead to further TB transmission and the development of resistant strains. Hence, factors related to these events should be explored and addressed. This study aims to fill the gap in evidence by identifying the determinants of unsuccessful TB treatment outcomes in Eritrea's Northern Red Sea region. METHODS: A retrospective cohort study was conducted in Eritrea's Northern Red Sea region. Data collected using a data extraction tool was analyzed using Stata version 13. Frequencies, proportions, median and standard deviations were used to describe the data. Furthermore, univariable and multivariable logistic regression analysis were performed to determine the risk factors for unsuccessful TB treatment outcomes. Crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence interval (CI) presented and p-value < 0.05 was considered statistically significant. RESULTS: Among 1227 TB patients included in this study, 9.6% had unsuccessful TB treatment outcomes. In multivariable logistic regression analysis, TB cases 55-64 years old (AOR: 2.75[CI: 1.21-6.32], p = 0.016) and those ≥ 65 years old (AOR: 4.02[CI: 1.72-9.45], p = 0.001) had 2.7 and 4 times higher likelihood of unsuccessful TB treatment outcome respectively. In addition, HIV positive TB patients (AOR: 5.13[CI: 1.87-14.06], p = 0.002) were 5 times more likely to have unsuccessful TB treatment outcome. TB treatment in Ghindae Regional Referral Hospital (AOR: 5.01[2.61-9.61], p < 0.001), Massawa Hospital (AOR: 4.35[2.28-8.30], p< 0.001) and Nakfa Hospital (AOR: 2.53[1.15-5.53], p = 0.021) was associated with 5, 4 and 2.5 higher odds of unsuccessful TB treatment outcome respectively. CONCLUSION: In this setting, old age, HIV co-infection and health facility were the independent predictors of unsuccessful TB treatment outcome.

Health-Related Quality of Life in Tuberculosis Patients in Eritrea: Comparison Among Drug-Susceptible and Rifampicin/Multidrug-Resistant Tuberculosis Patients.

BACKGROUND: Despite the negative impact of tuberculosis (TB) on patients' quality of life, TB control programs focus on biological and clinical parameters to manage and monitor TB patients. In our setting, patients' perception of their experience with TB and the impacts of TB on patients' physical, mental, and social wellbeing remain unknown. OBJECTIVE: The objective of this study was to evaluate the health-related quality of life (HRQOL) among rifampicin/multidrug-resistant TB (RR/MDR-TB) in comparison to drug-susceptible TB (DS-TB) patients in Eritrea. METHODS: A cross-sectional study was conducted in RR/MDR-TB and DS-TB patients under treatment. Anonymized data collected using the WHOQOL-BREF questionnaire were analyzed using SPSS version 23. Frequency, mean and standard deviation were used to describe the data. Mean group score comparison and relationship between variables were assessed using t-test. Domain score was calculated with a mean score of items within each domain and scaled positively, a higher (increasing) score denoting a higher quality of life. Internal consistency was measured using Cronbach's alpha and statistical significance was set at p < 0.05. RESULTS: A total of 92 patients (46 RR/MDR-TB and 46 DS-TB) participated in the study. Environmental (40.63 ± 10.72) and physical domains (61.80 ±17.18) were the two most affected domains in RR/MDR-TB and DS-TB patients, respectively. The psychological domain was the least affected domain in RR/MDR-TB (48.28 ± 20.83) and DS-TB patients (76.63 ±15.32). RR/MDR-TB patients had statistically lower mean scores in all domains than DS-TB patients. CONCLUSION: HRQOL was impaired in both groups, but RR/MDR-TB patients had a worse health-related quality of life.

Diabetes Mellitus and Its Associated Factors in Tuberculosis Patients in Maekel Region, Eritrea: Analytical Cross-Sectional Study.

BACKGROUND: Both diabetes mellitus (DM) and tuberculosis (TB) are among the leading causes of morbidity and mortality in Eritrea. TB-DM comorbidity is known to complicate TB care, control and prevention. However, systematically studied epidemiological data on TB-DM comorbidity and its associated risk factors are lacking in this country. OBJECTIVE: This study aimed to assess the prevalence of DM and its associated factors among TB patients in the Maekel region, Eritrea. METHODS: Analytical cross-sectional study was conducted in eleven TB diagnostic and treatment sites. Pretested data extraction tool was used to collect data from medical records. Prevalence data were analysed using frequencies, proportions and median. To determine DM risk factors, univariable and multivariable logistic regression analysis was done with 95% CI and p value < 0.05 considered significant. RESULTS: Out of total eligible (1134) TB cases, DM prevalence was 9.88%. Age and BMI were identified as independent risk factors for DM among TB patients. Higher odds of DM were found among TB patients aged 45-54 (aOR: 4.85[1.39-16.94], p= 0.013) and those ≥55 (aOR: 6.99[2.12-23.04], p= 0.001). TB cases with normal BMI were two times more likely to have DM (aOR: 2.00[1.23-3.26], p= 0.005) compared to those underweight. CONCLUSION: The prevalence of DM among TB cases observed in this study is high, a clarion call to scale up current efforts to integrate TB-DM services within routine care. Furthermore, age and BMI were identified as independent risk factors for DM in TB cases, pointing to the need to pay attention to age and BMI status when managing this co-morbidity.

Self medication practice and associated factors among students of Asmara College of Health Sciences, Eritrea: a cross sectional study.

BACKGROUND: Self-medication is a common practice globally and the resulting irrational drug use is raising concerns. Up-to-date there is no systematic study conducted on self medication practice among students or the general community in Eritrea. The present study aimed to determine the prevalence of self-medication practice and its influencing factors among students of Asmara College of Health Science. METHODS: A cross sectional study was conducted from 21st May -15th June 2018. Data on self medication practice and its associated factors was collected using a self-administered questionnaire. Data analysis was done using SPSS - 23 and explained with descriptive and inferential statistics. RESULTS: A total of 313 students responded to the questionnaire with a response rate of 93.6%. The overall prevalence of self-medication practice was 79.2%. Headache and fever were reported as the most common complaint related to self-medication practice. Among the reasons for self medication practice, prior experience was the most frequently reported. Analgesics, antipyretic and antibacterial were the leading class of medicine used in self-medication practice while adverse drug reactions were reported by 9.2% of respondents. In this study, sex, income, and school of study were found to be the independent predictors for self-medication practice. CONCLUSION: National guideline on medicine access should be developed and strong measures should be implemented to halt the selling of medications without a proper prescription. In addition, students should be educated on the consequences of self-medication practices.