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Survival and health status of DOTS tuberculosis patients in rural Lao PDR.

Barennes H, Keophithoun T, Nguyen TH, Strobel M, Odermatt P - BMC Infect. Dis. (2010)

Bottom Line: Low compliance was associated with poor accessibility to health care (p = 0.01) and symptomatic improvement (p = 0.02).Additionally, it showed that follow-up of TB patients is feasible although the patients lived in very remote area of Laos.Follow-up should be strengthened as it can improve patient compliance, and allow contact tracing, detection of new cases and collection of accurate treatment outcome information.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR. hubert.barennes@auf.org

ABSTRACT

Background: Contact tracing of tuberculosis (TB) patients is rarely performed in low-income countries. Our objective was to assess the outcome of and compliance with directly observed treatment (DOTS) of TB patients over a 3 year period in rural Lao PDR.

Methods: We performed a retrospective cohort study in which we enrolled TB patients who started DOTS treatment at Attapeu Provincial Hospital. We traced, through hospital records, all patients in their residential village. We conducted a standardized questionnaire with all TB patients and performed physical and anthropometric examinations as well as evaluations of compliance through counting of treatment pills at home and at the health facilities.

Results: Of 172 enrolled TB patients (sex ratio female/male: 0.52, mean age: 46.9 years ± 16.9), 26 (15.1%) died. These had a lower weight at the start (34.6 vs. 40.8 kg, p < 0.001) and were less compliant (91.6% vs. 19.2%, p < 0.001) than survivors. Low compliance was associated with poor accessibility to health care (p = 0.01) and symptomatic improvement (p = 0.02). Survivors had persistently poor health status. They were underweight (54.7%), and still had clinical symptoms (53.5%), including dyspnoea (28.8%) and haemoptysis (9.5%).

Conclusion: Our study suggests a lower rate of survival than expected from official statistics. Additionally, it showed that follow-up of TB patients is feasible although the patients lived in very remote area of Laos. Follow-up should be strengthened as it can improve patient compliance, and allow contact tracing, detection of new cases and collection of accurate treatment outcome information.

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Related in: MedlinePlus

Sputum examination during the follow-up of tuberculosis patients in Attapeu, Lao PDR. Not all patients underwent a sputum examination which possibly underestimated the number of positive sputum over time.
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Figure 2: Sputum examination during the follow-up of tuberculosis patients in Attapeu, Lao PDR. Not all patients underwent a sputum examination which possibly underestimated the number of positive sputum over time.

Mentions: We performed, at the time of DOTS enrolment, 166 (96.5%) sputum tests. At months 2, 5, and 8 after enrolment, the rates of sputum testing was 73.9% (n = 108), 63.0% (n = 92) and 55.4% (n = 81) respectively. After 2 months, 5 of 142 (3.5%) sputum follow-up examinations remained positive. Three of these were negative at 5 months, one not checked after 5 months was reported negative at 8 months of treatment, and data of one patient was not available. No sputum was reported positive after 5 and 8 months treatment (Figure 2).


Survival and health status of DOTS tuberculosis patients in rural Lao PDR.

Barennes H, Keophithoun T, Nguyen TH, Strobel M, Odermatt P - BMC Infect. Dis. (2010)

Sputum examination during the follow-up of tuberculosis patients in Attapeu, Lao PDR. Not all patients underwent a sputum examination which possibly underestimated the number of positive sputum over time.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2944351&req=5

Figure 2: Sputum examination during the follow-up of tuberculosis patients in Attapeu, Lao PDR. Not all patients underwent a sputum examination which possibly underestimated the number of positive sputum over time.
Mentions: We performed, at the time of DOTS enrolment, 166 (96.5%) sputum tests. At months 2, 5, and 8 after enrolment, the rates of sputum testing was 73.9% (n = 108), 63.0% (n = 92) and 55.4% (n = 81) respectively. After 2 months, 5 of 142 (3.5%) sputum follow-up examinations remained positive. Three of these were negative at 5 months, one not checked after 5 months was reported negative at 8 months of treatment, and data of one patient was not available. No sputum was reported positive after 5 and 8 months treatment (Figure 2).

Bottom Line: Low compliance was associated with poor accessibility to health care (p = 0.01) and symptomatic improvement (p = 0.02).Additionally, it showed that follow-up of TB patients is feasible although the patients lived in very remote area of Laos.Follow-up should be strengthened as it can improve patient compliance, and allow contact tracing, detection of new cases and collection of accurate treatment outcome information.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR. hubert.barennes@auf.org

ABSTRACT

Background: Contact tracing of tuberculosis (TB) patients is rarely performed in low-income countries. Our objective was to assess the outcome of and compliance with directly observed treatment (DOTS) of TB patients over a 3 year period in rural Lao PDR.

Methods: We performed a retrospective cohort study in which we enrolled TB patients who started DOTS treatment at Attapeu Provincial Hospital. We traced, through hospital records, all patients in their residential village. We conducted a standardized questionnaire with all TB patients and performed physical and anthropometric examinations as well as evaluations of compliance through counting of treatment pills at home and at the health facilities.

Results: Of 172 enrolled TB patients (sex ratio female/male: 0.52, mean age: 46.9 years ± 16.9), 26 (15.1%) died. These had a lower weight at the start (34.6 vs. 40.8 kg, p < 0.001) and were less compliant (91.6% vs. 19.2%, p < 0.001) than survivors. Low compliance was associated with poor accessibility to health care (p = 0.01) and symptomatic improvement (p = 0.02). Survivors had persistently poor health status. They were underweight (54.7%), and still had clinical symptoms (53.5%), including dyspnoea (28.8%) and haemoptysis (9.5%).

Conclusion: Our study suggests a lower rate of survival than expected from official statistics. Additionally, it showed that follow-up of TB patients is feasible although the patients lived in very remote area of Laos. Follow-up should be strengthened as it can improve patient compliance, and allow contact tracing, detection of new cases and collection of accurate treatment outcome information.

Show MeSH
Related in: MedlinePlus