Factors Associated With Unsuccessful Treatment Outcome Among New Pulmonary Tuberculosis Patients in Malaysia: A Retrospective Cohort Study
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Abstract
Introduction: Achieving the World Health Organization's (WHO) target treatment success rate for new tuberculosis (TB) cases remains a challenge despite the TB End strategy and ongoing control efforts. Unsuccessful treatment outcomes heighten the risk of disease transmission and the emergence of drug resistance. This research aims to identify the patterns of TB treatment outcomes and explore the determinants of unsuccessful treatment among newly diagnosed pulmonary tuberculosis (PTB) patients in Malaysia. Materials and methods: A retrospective cohort study analysed 39,117 new pulmonary TB cases from the National Tuberculosis Database (TBIS) between January 2018 and January 2022. Multiple logistic regression determined factors associated with unsuccessful outcomes, using significance at p-value < 0.05. Results: Among the patients, 84.9% reported successful treatment, while 15.1% had unsuccessful outcomes, attributed to death (59.1%), loss to follow-up (23.2%), and not evaluated (15.0%). Factors such as age over 40 years old, male sex, Indian ethnicity, no formal education, urban residency, unemployment, smoking, HIV status, absence of BCG scar, positive sputum smear, severe initial chest x-ray results, no DOT supervision, and passive case detection significantly increased the risk of unsuccessful treatment. Conclusion: The study highlights specific sociodemographic and clinical factors linked to unsuccessful TB treatment outcomes, suggesting the need for targeted interventions in TB control programs and risk assessment strategies.
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World Health Organization. Global tuberculosis report [Internet]. Geneva: World Health Organization; 2022 [cited 2023 June 20]. Available from:https://www.iom.int/sites/g/files/tmzbdl486/files/documents/2023-03/Global-TB-Report-2022.pdf
Lye KH, Kadir MNA, Noordin NM, Teh SY. Tuberculosis elimination in Malaysia by 2035: Linkages and implications to SDGs. International Journal of Social Science and Humanity. 2019;9(4):126-32. doi: 10.18178/ijssh.2019.9.4.1003
World Health Organization. The End TB Strategy [Internet]. Geneva: World Health Organization; 2015 [cited 2023 June 22]. Available from: https://www.who.int/publications/i/item/WHO-HTM-TB-2015.19.
World Health Organization. Implementing the End TB Strategy: The Essentials 2022 Update [Internet]. Geneva: World Health Organization; 2022 [cited 2023 June 4]. Available from: https://www.who.int/docs/default-source/documents/tuberculosis/end-tb-essential3923df7f247e420f953605a7a624febe.pdf?sfvrsn=e1ba6289_1.
Bahagian Kawalan Penyakit. Manual sistem maklumat Tibi kebangsaan (semakan 2018). Putrajaya: Bahagian Kawalan Penyakit Kementerian Kesihatan Malaysia; 2019.
Wen Y, Zhang Z, Li X, Xia D, Ma J, Dong Y, et al. Treatment outcomes and factors affecting unsuccessful outcome among new pulmonary smear positive and negative tuberculosis patients in Anqing, China: a retrospective study. BMC Infectious Diseases. 2018;18(1):104. doi: 10.1186/s12879-018-3019-7
Fun WH. Health and economic impact of tuberculosis management in Malaysia [Internet]. Monash: Monash University; 2017 [cited 2023 May 20]. Available from https://doi.org/10.4225/03/58af9338dbdc0
Araia ZZ, Kibreab F, Kibrom AA, Mebrahtu AH, Girmatsion MG, Teklehiwet YW, et al. Determinants of unsuccessful tuberculosis treatment outcome in Northern Red Sea region, Eritrea. PLOS ONE. 2022;17(8):1-13. doi: 10.1371/journal.pone.0273069
World Health Organisation. Summary of tuberculosis data [Internet]. 2022. [cited June 21]. Available from: https:// worldhealthorg .shinyapps.i o/TBrief/? inputs&sidebar Collapsed= true&entity _ type=%22 country%22& iso2 =%22M Y%22& sidebarItem Expande d=null.
The World Bank Data. Tuberculosis treatment success rate (% of new cases) [Internet]. 2023 [cited July 5]. Available from: https://data.worldbank.org/indicator/SH.TBS.CURE.ZS.
Ministry of Health. National stragtegic plan for tuberculosis control (2016-2020) [Internet]. Putrajaya: Disease Control Division (TB/ Leprosy Sector), Ministry of Health; 2016 [cited 2022 April 23].
Zulkipli ZA, Mohd Salleh MAH, Ahmed MN. Pulmonary tuberculosis: treatment outcomes and factors associated with poor treatment outcome in Pahang, Malaysia. IIUM Medical Journal Malaysia. 2018;17(1). doi: 10.31436/imjm.v17i1.899.
Shariff NM, Safian N. Diabetes mellitus and its influence on sputum smear positivity at the 2nd month of treatment among pulmonary tuberculosis patients in Kuala Lumpur, Malaysia: A case control study. International Journal of Mycobacteriology. 2015;4(4):323-9. doi: 10.1016/j.ijmyco.2015.09.003.
Selimin DS, Ismail A, Ahmad N, Ismail R, Mohd Azman NF, Azman A. Tuberculosis treatment outcome in patients with TB-HIV coinfection in Kuala Lumpur, Malaysia. Journal of Tropical Medicine. 2021;2021:10. doi: 10.1155/2021/9923378
Ibrahim MN, Husain NRN, Daud A, Chinnayah T. Epidemiology and risk factors of delayed sputum smear conversion in Malaysian aborigines with smear-positive pulmonary tuberculosis. International Journal of Environmental Research and Public Health. 2022;19. doi: https://doi.org/10.3390/ijerph19042365
Arsad FS, Ismail NH. Unsuccessful treatment outcome and associated factors among smear-positive pulmonary tuberculosis patients in Kepong district, Kuala Lumpur, Malaysia. Journal of Health Research. 2022;36(3):484-93. doi: 10.1108/JHR-10-2020-0478
Mahato RK, Laohasiriwong W, Koju R. The role of Diabetes mellitus comorbidity on tuberculosis treatment outcomes in Nepal: A prospective cohort study. Southeastern European Journal of Public Health. 2022;2:1-13. doi: 10.11576/seejph-5329
Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, et al. Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study. PLoS ONE. 2022;15(4). doi: https://doi.org/10.1371/journal.pone.0231986
Debash H, Nega J, Bisetegn H, Tesfaw G, Feleke DG, Ebrahim H, et al. Tuberculosis treatment outcomes and its predictors among tuberculosis patients registered at Tefera Hailu Memorial General Hospital, Sekota Town, Northeast Ethiopia: A seven-year retrospective study. Canadian Journal of Infectious Diseases and Medical Microbiology. 2023;2023:9. doi: 10.1155/2023/4212312
Ministry of Health. Clinical practice guideline management of tuberculosis [Internet]. Putrajaya, Malaysia: Malaysian Health Technology Assessment Section (MaHTAS); 2021 [cited 2022 August 18]. Available from https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Respiratory/CPG-_Management_of_Tuberculosis_(4th_Edition).pdf
World Health Organization. Global tuberculosis report [Internet]. Geneva: World Health Organization; 2021 [cited 2023 June 20]. Available from: https://www.who.int/publications/digital/global-tuberculosis-report-2021/
World Health Organization. Definitions and reporting framework for tuberculosis. Geneva: World Health Organization; 2013 [cited 2022 October 23]. Available from: https://www.who.int/publications/i/item/9789241505345.
Hashim JH, Adman MA, Hashim Z, Mohd Radi MF, Kwan SC. Covid-19 Epidemic in Malaysia: Epidemic progression, challenges, and response. Front Public Health. 2021;9:1-9. doi: 10.3389/fpubh.2021.560592.
Feyisa JW, Kitila KM, Lemu JC, Hunde MD, Hunde AD. Healthcare-seeking delay during Covid-19 pandemic among tuberculosis patients in Ilubabor zone health facilities, south-west Ethiopia. SAGE Open Med. 2022;10:1-10. doi: 10.1177/20503121221142469.
Tom W, Luis C, Peter M. Tackling two pandemics: A plea on World Tuberculosis Day. Lancet Respiratory Medicine 2020;8(6):536-8. doi: https://doi.org/10.1016/S2213-2600(20)30151-X
Melese A, Zeleke B. Factors associated with poor treatment outcome of tuberculosis in Debre Tabor, northwest Ethiopia. BMC Res Notes. 2018;11(1):25. doi: 10.1186/s13104-018-3129-8.
Abebe G, Bonsa Z, Kebede W. Treatment outcomes and associated factors in tuberculosis patients at Jimma University Medical Center: A 5‑year retrospective study. International Journal of Mycobacteriology. 2022;8(1):35-41. doi: 10.4103/ijmy.ijmy_177_18.
Lin HS, Cheng CW, Lin MS, Chou YL, Chang PJ, Lin JC, Ye JJ. The clinical outcomes of oldest old patients with tuberculosis treated by regimens containing rifampicin, isoniazid, and pyrazinamide. Clinical Interventions in Aging. 2016; 11, 299–306. doi:10.2147/CIA.S95411
Teo AKJ, Morishita F, Islam T, Viney K, Ong CWM, Kato S, et al. Tuberculosis in older adults: challenges and best practices in the Western Pacific Region. The Lancet Regional Health Western Pacific 2023;36:100770. doi: https://doi.org/10.1016/j.lanwpc.2023.100770
Lampalo M, Jukić I, Bingulac-Popović J, Stanić HS, Barišić B, Popović-Grle S. The Role of Cigarette Smoking and Alcohol Consumption in Pulmonary Tuberculosis Development and Recurrence. Acta Clin Croat. 2019;58(4):590-594. doi: 10.20471/acc.2019.58.04.04.
Thomas BE, Thiruvengadam K, S R, Kadam D, Ovung S, Sivakumar S, Bala Yogendra Shivakumar SV, Paradkar M, Gupte N, Suryavanshi N, Dolla CK, Gupte AN, Kohli R, Pradhan N, Sivaramakrishnan GN, Gaikwad S, Kagal A, Dhanasekaran K, Deluca A, Golub JE, Mave V, Chandrasekaran P, Gupta A; CTRIUMPH-RePORT India Study. Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored. PLoS One. 2019;14(7):e0220507. doi: 10.1371/journal.pone.0220507.
Lima S, de Araujo K, Nunes MAP, Nunes C. Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis. Heliyon. 2021;7(4):e06788. doi: 10.1016/j.heliyon.2021.e06788.
Suliman Q, Lim PY, Md. Said S, Tan K-A, Mohd. Zulkefli NA. Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia. Scientific Reports. 2022;12(1):745. doi: 10.1038/s41598-021-04742-2.
Matakanye H, Tshitangano TG, Mabunda JT, Maluleke TX. Knowledge, Beliefs, and Perceptions of TB and Its Treatment amongst TB Patients in the Limpopo Province, South Africa. Int J Environ Res Public Health. 2021 Oct 2;18(19):10404. doi: 10.3390/ijerph181910404.
Burusie A, Enquesilassie F, Addissie A, Dessalegn B, Lamaro T. Effect of smoking on tuberculosis treatment outcomes: A systematic review and meta-analysis. PLoS One. 2020;15(9):e0239333. doi: 10.1371/journal.pone.0239333
Khan AH, Sulaiman SAS, Hassali MA, Khan KU, Ming LC, Mateen O, et al. Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study. BMC Public Health. 2020;20(1):854. doi: 10.1186/s12889-020-08856-6.
Teferi MY, El-Khatib Z, Boltena MT, Andualem AT, Asamoah BO, Biru M, et al. Tuberculosis treatment outcome and predictors in Africa: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2021;18(20):10678. doi:10.3390/ijerph182010678.
Kassa GM, Merid MW, Muluneh AG, Fentie DT. Sputum smear grading and associated factors among bacteriologically confirmed pulmonary drug-resistant tuberculosis patients in Ethiopia. BMC Infect Dis. 2021;21(1):238. doi: 10.1186/s12879-021-05933-y.
Kementerian Kesihatan Malaysia. Clinical practice guideline management of tuberculosis. Putrajaya: Malaysian Health Technology Assessment Section (MaHTAS); 2021.
Pereira Dos Santos PC, Messina NL, Dias De Oliveira R, Vieira Da Silva P, Puga MAM et al. Effect of BCG vaccination against Mycobacterium tuberculosis infection in adult Brazilian health-care workers: a nested clinical trial. The Lancet Infectious Diseases. 2024; 24(6):594–601. https://doi.org/10.1016/S1473-3099(23)00818-6
Huangfu P, Ugarte-Gil C, Golub J, Pearson F, Critchley J. The effects of diabetes on tuberculosis treatment outcomes: An updated systematic review and meta-analysis. Int J Tuberc Lung Dis. 2019;23(7):783-96. doi: 10.5588/ijtld.18.0433.
Zhang H, Liu X, Xu C, Hu D, Li X, Li T, et al. Guiding tuberculosis control through the Healthy China Initiative 2019-2030. China CDC Wkly. 2020;2:948-50.Doi: 10.46234/ccdcw2020.236.
The World Bank . China: Tuberculosis Control Project [Internet]. 2010. Available from: https://www.worldbank.org/en/news/feature/2010/09/24/china-tuberculosis-control-project0
Togun T, Kampmann B, Stoker NG, Lipman M. Anticipating the impact of the Covid-19 pandemic on TB patients and TB control programmes. Annals of Clinical Microbiology and Antimicrobials. 2020;19(1):21. doi: 10.1186/s12941-020-00363-1.