LOSS TO FOLLOW-UP AND ASSOCIATED FACTORS AMONG ADULT TUBERCULOSIS PATIENTS TREATED AT PUBLIC HEALTH FACILITIES IN WARDER DISTRICT, SOMALI REGION, EAST ETHIOPIA: A FIVE-YEAR RETROSPECTIVE FOLLOW-UP STUDY

Abstract

Background: Tuberculosis (TB) remains a major public health problem throughout the world particularly in resource limited countries. Ethiopia is among the top twenty high TB burden countries. Loss to follow-up (LTFU) is one of the major obstacles in the fight against TB as it presents serious implications for the patients, their families, and community who may become infected with TB. There is limited data on proportion of LTFU and its associated factors among adult TB patients treated at public health facilities in Warder district. Objective: To assess LTFU and associated factors among adult TB patients treated from January 1, 2016 to December 31, 2020 at public health facilities in Warder District, Somali Region, East Ethiopia from November 02-17,2021. Methods: A five-year retrospective follow-up study was conducted on TB unit register of 589 adult TB patients. A systematic random sampling technique was used to recruit study participants and structured data extraction format was used for data collection. Data was entered and cleaned using EpiDATA version 3.02 and analyzed by STATA version 14.0 statistical packages. Descriptive and analytical methods (bivariate and multivariate logistic regression) were used to identify factors associated with the primary outcome of interest (LTFU) along with calculation of PORs and AORs with 95%CI at P<0.05 statistical significance. Results: Out of 589 TB patients included in this study, 221 (37.5%) were cured, 198 (33.6%) completed treatment, 26 (4.4%) died, 9 (1.5%) failed treatment, and 35 (5.9%) were transferred out to another health facility. Ninety eight (16.6%) TB patients were LTFU. Age 55 to 64 years (AOR 4.4, 95%CI 1.9-9.9), male sex (AOR 1.8, 95%CI 1.1-2.9), distance ≥10Km from public health facility (AOR 4.9, 95%CI 2.5-9.4), and having past TB treatment history (AOR 2.3, 95%CI 1.2-4.4) were significantly associated to higher likelihood of LTFU while positive baseline smear result (AOR 0.48, 95%CI 0.24-0.96) was associated to lower probability of LTFU. Conclusion: One out of six TB patients were LTFU after initiation of TB treatment in Warder District. Patient’s clinical characteristics and distance to HF were significantly associated with LTFU. Community identification and tracing of patients who discontinue their treatment with special focus on the elderly, male patients, smear negative patients and retreatment cases is crucial to reduce LTFU.