Risk Factors and the Evolution of Tuberculosis Cases in the Laayoune and Tarfaya Provinces of Morocco

Abstract

Background: Tuberculosis remains a major public health concern in Morocco. The main objective of this study was to evaluate its prevalence and analyze how risk factors influence the development of the disease and treatment failure rates in the Laayoune and Tarfaya provinces of Morocco.

Methods: This research took the form of a retrospective study of 1,333 tuberculosis cases, with all forms being combined, that were reported to the Center for the Diagnosis and Treatment of Respiratory Diseases in Laayoune between 2006 and 2012. We utilised the chi-square/Fisher's test for categorical analysis. Following this, a multivariate logistic analysis was undertaken to discern factors linked to Pulmonary/ extrapulmonary tuberculosis, presenting findings through odds ratios (OR) accompanied by 95% confidence intervals (CIs). Post-estimation analyses using the 'Lincom' command were executed to compute adjusted ORs and 95% CIs, amalgamating effects from preceding logistic models.

Results: This study found that 61.2% of patients were diagnosed with a form of pulmonary tuberculosis, while 38.8% presented extrapulmonary tuberculosis, including 12.2% lymph node cases and 15.9% pleural cases. In terms of treatment outcomes, 36.5% managed to complete their treatment, while 24.8% of pulmonary tuberculosis patients were cured. Nevertheless, 21.1% of patients needed to be transferred to other cities, 14.3% were lost to follow-up, and 3.2% died during treatment. 38.7% of patients had unfavourable outcomes, while 61.3% had favorable outcomes. A multivariate logistic analysis identified the risk factors associated with pulmonary and extrapulmonary tuberculosis and any adverse outcomes. Patients in some age groups had a significantly higher risk of pulmonary tuberculosis, when adjusted for diabetes (aOR=13.16, 95% CI[4.54-38.12]), more so once smoking was also taken into account (aOR=31.49, 95% CI [9.55-103.8]). Additionally, this study highlights how the high prevalence of pulmonary tuberculosis can be linked to smoking and a rural origin, with it underscoring a greater vulnerability among younger (aOR =7,16, 95% CI[2,34-21,83])  and elderly adults (aOR= 7,78 95% CI [2,24-27,00]), particularly those with diabetes.

The study identifies challenges in terms of diagnostic delays and providing access to healthcare in rural areas. The study’s findings help improve our understanding of tuberculosis and will inform the development of more effective preventive strategies.