Management of pulmonary tuberculosis in Tajikistan: which factors determine hospitalization?


Thierfelder, C; Makowiecka, K; Vinichenko, T; Aye, R; Edwards, P; Wyss, K; (2008) Management of pulmonary tuberculosis in Tajikistan: which factors determine hospitalization? Tropical medicine & international health, 13 (11). pp. 1364-1371. ISSN 1360-2276 DOI: https://doi.org/10.1111/j.1365-3156.2008.02149.x

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Abstract

To assess predictors for tuberculosis hospitalization and treatment outcome in Tajikistan. Stratified, single stage cluster sample survey of 1495 adult patients with pulmonary TB during 2 calendar years (2005-2006) from the registries of 10 TB centres chosen by simple random sampling. The primary outcome was referral to hospital. Logistic regression was conducted to test associations with the study outcome using linearization and a variance formula. Prevalence of hospitalization for tuberculosis was 58%. The odds of patients with smear-positive tuberculosis being referred were three times those of smear-negative patients [OR 2.99 (95% CI 1.81-4.96)]. Other predictors for hospitalization were the availability of TB hospital beds within the same district [OR 2.15 (95% CI 1.22-3.76)] and male gender [OR 1.46 (95% CI 1.07-2.48)]. The overall treatment success was 80%. Hospitalization of patients with pulmonary tuberculosis was determined by positive sputum smear, supply of hospital beds, and gender. Reducing hospitalization with support of national guidelines is not expected to have a negative impact on treatment outcome and spread of disease, but could lead to improved efficiency and effectives of health service delivery for pulmonary tuberculosis in Tajikistan.Evaluer les predicteurs de l'hospitalisation pour tuberculose (TB) et du resultat du traitement au Tadjikistan. Etude stratifiee en une seule etape sur un groupe d'echantillon de 1495 patients adultes avec TB pulmonaire pendant 2 annees (2005 - 2006) a partir des registres de dix centres de TB choisis par tirage aleatoire simple. L'objectif primaire etait le transfert vers un hopital de reference. La regression logistique a ete appliquee afin de tester les associations entre les resultats de l'etude, en utilisant une linearisation et une formule de la variance. La prevalence de l'hospitalisation pour TB etait de 58%. Les chances de transfert pour les patients avec un frottis positif TB etaient trois fois plus elevees que celles de patients a frottis negatif (OR: 2,99 [IC95%: 1,81-4,96]). D'autres predicteurs d'hospitalisation etaient la disponibilite de lits d'hospitalisation pour la TB dans le meme district (OR: 2,15 [IC95%: 1,22 a 3,76]) et le sexe masculin (OR: 1,46 [IC95%: 1,07-2,48]). Le succes global de traitement etait de 80%. L'hospitalisation des patients atteints de TB pulmonaire etait determinee par le frottis positif, la disponibilite de lits d'hopital, et le sexe. La reduction de l'hospitalisation basee sur les directives nationales ne devrait pas avoir un impact negatif sur le resultat du traitement et la propagation de la maladie, mais pourrait mener a une amelioration de l'efficacite des services de sante effectifs pour la TB pulmonaire au Tadjikistan.Evaluar los factores que predicen la hospitalizacion por tuberculosis y el resultado del tratamiento en Tajikistan. Estudio estratificado, con muestreo por conglomerados en una etapa de 1495 pacientes adultos con TB pulmonar, utilizando los registros de 10 centros de TB escogidos mediante muestreo aleatorio simple durante 2 anos de calendario (2005-06). El resultado principal era el ser referido a un hospital. Se realizo una regresion logistica para probar las asociaciones con el resultado del estudio, utilizando linearizacion y una formula de varianza. La prevalencia de hospitalizacion para tuberculosis fue del 58%. La razon de posibilidades de un paciente con lamina positiva para tuberculosis de ser referido era tres veces mayor que aquellos con lamina negativa (OR 2.99 [95% CI 1.81-4.96]). Otros vaticinadores de hospitalizacion eran la disponibilidad de camas en hospitales para TB dentro del mismo distrito (OR 2.15 [95% CI 1.22 to 3.76]) y el ser hombre (OR 1.46 [95% CI 1.07-2.48]). El exito general del tratamiento era del 80%. La hospitalizacion de pacientes con tuberculosis pulmonar se determinaba mediante una lamina de esputo positiva, la disponibilidad de camas y el genero. El reducir la hospitalizacion con la ayuda de guias nacionales no se espera que tenga un impacto negativo sobre los resultados del tratamiento y la diseminacion de la enfermedad, pero podria llevar a una eficiencia mejorada y a una mayor efectividad de la entrega del servicio para tuberculosis pulmonar en Tajikistan.

Item Type: Article
Keywords: tuberculosis, hospitalization, Tajikistan, predictors, tuberculose, hospitalisation, Tadjikistan, predicteurs, Tuberculosis, hospitalizacion, Tajikistan, vaticinadores, CONSUMPTION, Adolescent, Adult, Age Distribution, Aged, Aged, 80 and over, Bed Occupancy, Cluster Analysis, Cross-Sectional Studies, Female, Health Planning Guidelines, Hospitalization, statistics & numerical data, Humans, Male, Middle Aged, Regression Analysis, Retreatment, Seasons, Sex Distribution, Sputum, microbiology, Tajikistan, epidemiology, Treatment Outcome, Tuberculosis, Pulmonary, epidemiology, microbiology, therapy, Young Adult
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 19055621
Web of Science ID: 261085800006
URI: http://researchonline.lshtm.ac.uk/id/eprint/6037

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