Assessment of multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in Sudan; findings and implications

ABSTRACT

Background: Multidrug-resistant tuberculosis (MDR-TB) has a socioeconomic impact and threatens global public health. We assessed treatment outcomes of MDR-TB and predictors of poor treatment outcomes in Sudan given current high prevalence rates.

Methods: Combined retrospective and prospective cohort study at Abu-Anga hospital (TB specialized hospital in Sudan). All patients with MDR-TB between 2013 and 2017 were targeted.

Results: A total of 156 patients were recruited as having good records, 117 (75%) were male, and 152 (97.4%) had pulmonary TB. Patients were followed for a median of 18 months and a total of 2108 person-months. The overall success rate was 63.5% and the mortality rate was 14.1%. Rural residency (P < 0.05) and relapsing on previous treatments (P < 0.05) were determinants of time to poor MDR-TB treatment outcomes.

Conclusion: Overall, more attention needs to be given to special MDR-TB groups that are highly susceptible to poor outcomes, i.e. rural patients. As a result, it is highly recommended to maintain total coverage of medicines for all MDR-TB patients for the entire period of treatment in Sudan. It is also recommended to instigate more treatment centers in rural areas in Sudan together with programs to enhance adherence to treatments including patient counseling to improve future outcomes.

KEYWORDS:

• Multidrug-resistant tuberculosis
• treatments
• outcomes
• predictors
• rural populations
• Sudan

Article highlights

• Multidrug-resistant tuberculosis (MDR-TB) has an appreciable socioeconomic impact and threatens global public health. The current study aimed to assess treatment outcomes of MDR-TB and predictors of poor treatment outcomes in Sudan.

• All MDR-TB patients with complete records admitted between 2013 and 2017 to a leading TB hospital in the capital of Sudan, Khartoum, were included in the study. Overall, 156 patients were included.

• Treatment success for patients with MDR-TB (defined by WHO criteria) was 63.5%, behind the global target of 75%

• Rural residency and relapsing on previous treatments were predictors of poor outcomes of MDR-TB treatment in this study.

• More effort is needed to tackle this disease in Sudan. This should include instigating more treatment centers in rural areas alongside programs to enhance adherence including greater patient counseling especially for patients who have difficulties in reading.

Acknowledgments

The authors acknowledge the staff of Abu-Anga Chest Hospital, Khartoum state, Sudan for the collaboration and facilitating this work. Special thanks also go to the data collectors for their help.

Declaration of interest

Hamdan Mustafa Hamdan Ali works for the National Tuberculosis Control Program, Federal Ministry of Health, Sudan.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.