Assessing TB infection control and preventive measures in TB patients in Chattogram metropolitan area

Abstract

Treatment failure is a serious problem faced by many national tuberculosis control programmes. A total of 534 patients were enrolled in this study after meeting inclusion criteria. After obtaining consent, they were interviewed for history of contact exposure via phone interviews. The outcomes were recorded and analyzed using STATA-13. There were 332 (62.2%) male and 202 (37.8%) females. Majority of the study subjects were adults (95.8%) and belonged to lower socioeconomic class (93.6%). Most of them were married (92.1%) and lived in nuclear families (95.1%). In case of type of dwelling, more than half of the respondents (56.7%) lived in slums. Ten patients (1.87%) were found to have treatment failure with equal proportions in both male and female (50%). In case of type of dwelling, most cases of treatment failure lived in isolated houses (40%) and most cases belonged to nuclear families (90%). All cases of treatment failure were adults and were married (100%). Most of them belonged to lower class (90%). Smoking was the most prevalent risk factor among the study subjects and was present in 243 (45.5%) study subjects. Other common risk factors were previous history of anti-TB treatment (15.7%), comorbidities like diabetes (14.8%), malnourishment (13.3%), immunosuppressive therapy (12.7%), contact with domestic animals (6.7%), consumption of raw milk (5.6%), and history of contact with infected people (4.5%). As for total duration of treatment, 531 (99.4%) patients had taken treatment for 6 months. Only three (0.56%) patients received treatment for a short duration of 2 months due to adverse drug reactions. During treatment, 17 (3.2%) patients skipped medications in between while 517 (96.8%) did not. A significant association was found between shorter duration of treatment (p<0.001) and history of skipping medications during treatment (p=0.037) against treatment outcome. On observing odds ratio, the odds of getting cured were higher (OR=1.53; 95% CI: 0.28 - 28.36) among patients who were being re-treated for the disease after treatment failure. In order to control the spread of PTB in Bangladesh, interventions such as strengthening diagnosis of pulmonary TB further, implementing targeted communication programs and active case finding to reduce patient level delays, expanding public-private mix to increase access to TB services