Trend of case notification and treatment outcome in tb management units in refugee settlements in Uganda. A fouryear retrospective analysis, 2014-2017

Abstract

Background: Tuberculosis (TB) is a major health challenge in refugee populations. Monitoring the key indicators of TB program performance is essential to improve the effectiveness of TB control in refugee camps.
Objective: To investigate trends of TB case notifications and treatment outcomes in refugee settlements in Uganda, 2014-2017.
Design: Retrospective descriptive cohort study
Settings: Thirty-three health facilities located in 12 refugee settlements
Subjects: All TB cases registered from January 1 2014 to December 31 2017
Results: A total of 794 TB cases of whom 63.4% were of age 15-44 years and 2.9% Extrapulmonary TB (EPTB) were registered. TB case notification increased from 89 in 2014 to 452 cases in 2017. From 2014 to 2017: male to female ratio for notification was ≥ 2.1:1; percentage of bacteriologically confirmed new and relapse pulmonary was 73.5% to 90.5%; and TB treatment success rate remained lower at 56.2% to 70.8%. On average 32.2% had unfavorable outcomes, including 22% lost to followup (LTFU), 4.5% not evaluated, 3.8% died, and 1.5% had treatment failure. Unsuccessful treatment was significantly associated with EPTB (AOR 11.4 95% CI (1.9-66.5).
Conclusion: During the study period: TB case notification continuously increased; TB cases were predominately by male and age 15-44 years; frequency of EPTB remained lower than the national data (7.3%); and TB treatment success was far below the global target (≥ 90%) which need to be improved. There was higher LTFU, not evaluated and death. Patients with EPTB who are at higher risk for unsuccessful treatment need special support.