Profile and determinants of unsuccessful tuberculosis outcome in rural Nigeria: Implications for tuberculosis control

Table 1 Demographic and clinical profile of rural tuberculosis patients, Nigeria, 2011-2012

Variables	n (%)
Age (yr)
≤ 40	728 (61.7)
> 40	452 (38.3)
Gender
Female	494 (41.9)
Male	686 (58.1)
Facility
Private	1035 (87.7)
Public	145 (12.3)
Treatment category
New	1099 (93.1)
Retreatment	81 (6.9)
Type of TB
Pulmonary TB	1134 (96.1)
Extrapulmonary TB	46 (3.9)
HIV status
HIV - positive	233 (19.7)
HIV - negative	947 (80.3)
Treatment regimen (n = 1099)
Regimen 1	579 (52.7)
Regimen 2	520 (47.3)

Regimen 1: 8-mo regimen; Regimen 2: 6-mo regimen. TB: Tuberculosis; HIV: Human immunodeficiency virus.

Table 2 Tuberculosis treatment outcomes stratified by human immunodeficiency virus status in rural Ebonyi, Nigeria, 2011-2012

Treatment outcome	Both HIV- and HIV+ n (%)	HIV-negative n (%)	HIV-positive n (%)	χ2(P value)
All TB cases				34.2 (< 0.001)
Successful	893 (75.7)	751 (79.3)	142 (60.9)
Unsuccessful	287 (24.3)	196 (20.7)	91 (39.1)
Failure	18 (1.5)	13 (1.4)	5 (2.1)	1.84 (0.18)
Death	129 (10.9)	75 (7.9)	54 (23.2)	49.0 (< 0.001)
Default	100 (8.5)	79 (8.3)	21 (9.0)	1.70 (0.19)
Transfer-out	40 (3.4)	29 (3.1)	11 (4.7)	3.76 (0.05)
Total	1180	947	233
Pulmonary TB				37.7 (< 0.001)
Successful	875 (77.2)	736 (81.0)	139 (61.8)
Unsuccessful	259 (22.8)	173 (19.0)	86 (38.2)
Failure	18 (1.6)	13 (1.4)	5 (2.2)	1.84 (0.18)
Death	121 (10.7)	69 (7.6)	52 (23.1)	50.3 (< 0.001)
Default	88 (7.8)	69 (7.6)	19 (8.4)	1.9 (0.17)
Transfer-out	32 (2.8)	22 (2.4)	10 (4.4)	5.3 (0.02)
Total	1134	909	225
Extrapulmonary TB				0.01 (0.47)1
Successful	18 (39.1)	15 (39.5)	3 (37.5)
Unsuccessful	28 (60.9)	23 (60.5)	5 (62.5)
Failure	0	0 (0)	0 (0)	-
Death	8 (17.4)	6 (15.8)	2 (25.0)	0.25 (0.5)1
Default	12 (26.1)	10 (26.3)	2 (25.0)	0.0 (0.68)1
Transfer-out	8 (17.4)	7 (18.4)	1 (12.5)	0.07 (0.64)1
Total	46	38	8
New cases				32.5 (< 0.001)
Successful	832 (75.7)	700 (79.4)	132 (60.8)
Unsuccessful	267 (24.3)	132 (20.6)	85 (39.2)
Failure	15 (1.4)	11 (1.2)	4 (1.4)	1.28 (0.26)
Death	118 (10.7)	67 (7.6)	51 (23.5)	49.7 (< 0.001)
Default	97 (8.8)	76 (8.6)	21 (9.7)	2.1 (0.15)
Transfer-out	37 (3.4)	28 (3.2)	9 (4.1)	1.86 (0.17)
Total	1099	882	217
Retreatment cases				1.8 (0.10)1
Successful	61 (75.3)	51 (78.5)	10 (62.5)
Unsuccessful	20 (24.7)	14 (21.5)	6 (37.5)
Failure	3 (3.7)	2 (3.1)	1 (6.3)	0.58 (0.44)1
Death	11 (13.6)	8 (12.3)	3 (18.8)	0.75 (0.31)1
Default	3 (3.7)	3 (4.6)	0 (0)	0.58 (0.59)1
Transfer-out	3 (3.7)	1 (1.5)	2 (12.5)	4.74 (0.08)1
Total	81	65	16

¹Fisher’s exact P-value was reported; TB: Tuberculosis; HIV: Human immunodeficiency virus; HIV+: HIV-positive; HIV-: HIV-negative.

Table 3 Multivariable logistic regression analysis of factors associated unsuccessful treatment outcomes among rural tuberculosis patients, Nigeria, 2011-2012

Variables	n = 1180 n (%)	Unsuccessful outcomes n (%)	Crude OR (95%CI)	Adjusted OR (95%CI)	Adjusted P-value
Total	1180	287 (24.3)
Age (yr)
≤ 40	728	168 (23.1)	1
> 40	452	119 (26.3)	1.2 (0.9-1.6)	1.3 (1.0-1.8)	0.08
Gender
Female	494	115 (23.3)	1
Male	696	172 (25.1)	1.1 (0.8-1.5)	1.2 (0.9-1.6)	0.25
Facility
Private	1035	210 (20.3)	1
Public	145	77 (53.1)	4.5 (3.1-6.4)	2.9 (1.9-4.4)	< 0.001
Type of TB
PTB smear positive	708	136 (19.2)	1
PTB smear negative	426	123 (28.9)	1.5 (1.1-1.9)	1.3 (1.0-1.8)	0.09
Extrapulmonary	46	28 (60.9)	5.3 (2.9-9.7)	2.7 (1.3-5.6)	0.009
Treatment category
New	1099	267 (24.3)	1
Retreatment	81	20 (24.7)	1.0 (0.6-1.7)	1.1 (0.6-1.9)	0.75
Regimen (n = 1099)
Regimen 1	579	157 (27.1)	1.4 (1.1-1.8)	1.3 (1.1-1.8)	0.04
Regimen 2	520	110 (21.2)
HIV status
Negative	947	196 (20.7)	1
Positive	233	91 (31.7)	2.5 (1.8-3.3)	2.1 (1.5-3.0)	< 0.001

Regimen 1: 8-mo regimen; Regimen 2: 6-mo regimen. TB: Tuberculosis; HIV: Human immunodeficiency virus.