Treatment outcome of tuberculosis treatment regimens in Kandahar, Afghanistan.

BACKGROUND: Tuberculosis (TB) is a chronic disease that mostly affects low-income countries. TB is transmitted through droplet aerosolization from a person with active pulmonary TB. Afghanistan is one of the 22 high TB burden countries where 39,445 people develop this disease and 7840 people die each year. Treatment outcome is one of the best measurements that explain how the current regimen works. MATERIAL AND METHODS: This was a retrospective cohort study, conducted in Kandahar Province, to find out the treatment outcome of anti-TB drugs regimens in TB patients. Data of pulmonary and extra-pulmonary TB patients, who fulfilled the eligible criteria of the study and were treated from 2005 to 2015, was retrieved from their medical record forms. RESULTS: Among 1000 TB patients, 599 (59.9%) were females and 401 (40.1%) males; most of the patients (678/1000 [67.8%]) were from Kandahar city while 322/1000 (32.2%) were from the other districts of Kandahar. Mean age of the patients were 36.1 years with SD of 19.3 years. Main signs and symptoms of fever, cough, and weight loss were present in 949/1000 (94.9%), 880/1000 (88%), and 544/1000 (54.4%) of the patients, respectively. On first visit 459/1000 (45.9%) patients were sputum AFB (acid fast bacilli) positive. Majority (247/459 [53.8%]) of these patients were AFB 2+. After 2 months of intensive anti-TB treatment, 9/459 (1.9%) patients were still AFB positive (1+). Treatment outcome of these 1000 patients showed that 479 (47.9%) completed the treatment, 298 (29.8%) were cured, 35 (3.5%) failed the anti-TB treatment, while 5 (0.5%) patients died. CONCLUSION: This clearly shows that TB is still one of the major threats to the people of Kandahar Province. There are cases of TB who do not respond to the first line regimens of anti-TB drugs advised by WHO and Afghan Ministry of Public Health (MoPH).

Determinants of treatment failure among tuberculosis patients in Kandahar City, Afghanistan: A 5-year retrospective cohort study.

Background: Tuberculosis (TB) is a preventable and treatable chronic disease. Afghanistan is among the high-TB-burden countries. The aim of this study is to find the determinants of treatment failure among TB patients in Kandahar City, Afghanistan. Methods: This was a retrospective cohort study conducted in Kandahar City during a period of 5 years (August 2014-July 2019). For data analysis; descriptive statistics, Chi-square test, and logistic regression were used. Results: Among 1416 TB patients, 894/1416 (63.1%) had pulmonary TB (PTB), whereas 522/1416 (36.9%) had extrapulmonary TB (EPTB). Mean age in these patients was 34.7 years while most of them were females in PTB (530/894 [59.3%]) and EPTB (340/522 [65.1%]) patients. Sputum smear was positive in 618/860 (71.9%) and 16/404 (4%) of PTB and EPTB patients, respectively. TB treatment failure was more in PTB (56/894 [6.3%]) than EPTB (4/522 [0.8%]). Chi-square test of TB cases showed that statistically significant determinants that may cause the treatment failure were re-treatment cases (crude odds ratio [COR] 7.7, P < 0.001), absence of fever (COR 5.2, P < 0.001), absence of cough (COR 1.7, P = 0.004), living in rural areas (COR 1.4, P = 0.035), and no weight loss (COR 1.3, P = 0.033). Binary logistic regression of the statistically significant variables revealed only absence of fever (adjusted odds ratio 6.0, P < 0.001) as the risk factor for treatment failure in TB patients. Conclusion: TB is still a major threat for Kandahar City. Low treatment success rate and increased number of defaulted cases are the major threats.

SWOT analysis of program design and implementation: a case study on the reduction of maternal mortality in Afghanistan.

This case study analyzes the design and implementation of the Basic Package of Health Services (BPHS) in Afghanistan by synthesizing the literature with a focus on maternal health services. The authors are a group of graduate students in the Brandeis University International Health Policy and Management Program and Sustainable International Development Program who used the experience in Afghanistan to analyze an example of successfully implementing policy; two of the authors are Afghan physicians with direct experience in implementing the BPHS. Data is drawn from a literature review, and a unique aspect of the case study is the application of the business-oriented SWOT analysis to the design and implementation of the program that successfully targeted lowering maternal mortality in Afghanistan. It provides a useful example of how SWOT analysis can be used to consider the reasons for, or likelihood of, successful or unsuccessful design and implementation of a policy or program. Copyright © 2015 John Wiley & Sons, Ltd.