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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林先和(Hsien-Ho Lin) | |
dc.contributor.author | Elias Onyoh | en |
dc.contributor.author | 歐以利 | zh_TW |
dc.date.accessioned | 2021-05-12T09:35:14Z | - |
dc.date.available | 2018-03-07 | |
dc.date.available | 2021-05-12T09:35:14Z | - |
dc.date.copyright | 2018-03-07 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-02-13 | |
dc.identifier.citation | REFERENCES
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Jul 2008;12(7):820-823. 16. Buu TN, Lonnroth K, Quy HT. Initial defaulting in the National Tuberculosis Programme in Ho Chi Minh City, Vietnam: a survey of extent, reasons and alternative actions taken following default. Int J Tuberc Lung Dis. Aug 2003;7(8):735-741. 17. Khan MS, Khan S, Godfrey-Faussett P. Default during TB diagnosis: quantifying the problem. Tropical Medicine & International Health. Dec 2009;14(12):1437-1441. 18. Wali A, Kumar AMV, Hinderaker SG, et al. Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan. Public Health Action. Mar 21 2017;7(1):21-25. 19. Balasubramanian R, Garg R, Santha T, et al. Gender disparities in tuberculosis: report from a rural DOTS programme in south India. The International Journal of Tuberculosis and Lung Disease. 2004;8(3):323-332. 20. Hill RC, Stevens W, Hill S, et al. Risk factors for defaulting from tuberculosis treatment: a prospective cohort study of 301 cases in The Gambia. 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Factors associated with patient and provider delays for tuberculosis diagnosis and treatment in Asia: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0120088. 26. Lake IR, Jones NR, Bradshaw L, Abubakar I. Effects of distance to treatment centre and case load upon tuberculosis treatment completion. Eur Respir J. Nov 2011;38(5):1223-1225. 27. Tadesse T, Demissie M, Berhane Y, Kebede Y, Abebe M. Long distance travelling and financial burdens discourage tuberculosis DOTs treatment initiation and compliance in Ethiopia: a qualitative study. BMC Public Health. May 01 2013;13:424. 28. Shete P, Haguma P, Miller C, et al. Pathways and costs of care for patients with tuberculosis symptoms in rural Uganda. The International Journal of Tuberculosis and Lung Disease. 2015;19(8):912-917. 29. Sai Babu B, Satyanarayana A, Venkateshwaralu G, et al. Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India. The International Journal of Tuberculosis and Lung Disease. 2008;12(9):1055-1058. 30. Squire SB, Belaye AK, Kashoti A, et al. 'Lost' smear-positive pulmonary tuberculosis cases: where are they and why did we lose them? Int J Tuberc Lung Dis. Jan 2005;9(1):25-31. 31. Mandal A, Basu M, Das P, Mukherjee S, Das S, Roy N. Magnitude and reasons of initial default among new sputum positive cases of pulmonary tuberculosis under RNTCP in a district of West Bengal, India. South East Asia Journal of Public Health. 2015;4(1):41-47. 32. Gopi P, Chandrasekaran V, Subramani R, Narayanan P. Failure to initiate treatment for tuberculosis patients diagnosed in a community survey and at health facilities under a DOTS programme in a district of South India. Indian Journal of Tuberculosis. 2005;52(3):153-156. 33. CIA. Cameroon. 2017; https://www.cia.gov/library/publications/the-world-factbook/geos/cm.html, 2018. 34. NTCP. PLAN STRATEGIQUE DE LUTTE CONTRE LA TUBERCULOSE AU CAMEROUN 2015-2019. 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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/handle/123456789/1268 | - |
dc.description.abstract | ABSTRACT
Background: Infectious pulmonary tuberculosis (TB) patients are universally expected to initiate therapy promptly after diagnosis in order to quickly halt the transmission of TB within any community. In reality, not all these diagnosed cases finally initiate TB therapy; hence, they become what is known as pre-treatment loss to follow-up (PLTFU) patients. Current figures of PLTFU range between 4 and 38% with great geographic heterogeneity. We aimed to investigate the proportion and risk factors of PLTFU of TB patients and the reasons of PLTFU in two regions of Cameroon. We also evaluated the impact of patient counseling and phone reminder on PLTFU. Methods: The three studies conducted include a retrospective (Jul-Dec 2015), prospective (Feb-Jul 2016) and an impact evaluation study, involving thirty-nine TB diagnostic and treatment units (DTUs). Pre-prepared data collection forms and semi-structured questionnaires were used to retrieve information from TB laboratory and treatment registers for all bacteriologically confirmed cases diagnosed during the study period. Data retrieved from both TB registers were cross-linked to identify any PLTFU cases (defined by failure to initiate treatment 7 days after diagnosis). Socio-demographic, sputum examination results and treatment information were collected. Travel distance/travel time between patient’s residence and DTU’s location were obtained using geographic information system tools. In the prospective study, all confirmed TB patients received counseling on the importance of treatment and the objectives for the study. Those who did not return for treatment on time were further contacted by phone or messages. Reasons for loss to follow-up were inquired and the patients were reminded to return for treatment. In the retrospective and prospective studies, we conducted univariable and multivariable logistic regression analyses to determine the risk factors of PLTFU. We also conducted Cox proportional hazard regression to determine the determinants of time to treatment in these patients. To evaluate the intervention of patient counseling and phone reminder (which was implemented in the prospective study), we combined the retrospective and prospective studies. Univariable and multivariable logistic regression analyses of the merged data were conducted to determine whether the intervention was associated with PLTFU, adjusting for other risk factors. We also performed a regression discontinuity analysis by adding a linear term of time trend and an interaction term between the intervention and the linear term of time trend to the logistic regression model. Results: In the retrospective study, 1174 cases of bacteriologically confirmed TB were identified. The PLTFU proportion was 16.7% (95% CI: 14.6- 18.8%) in these patients. Median time from first positive TB result to therapy initiation was two days (IQR: 2–3). In the multivariable logistic regression, significant risk factors for PLTFU included urban DTUs ([urban versus rural], adjusted odds ratio (aOR): 2.51, 95% CI: 1.51–4.17); travel time from home to DTUs (>30 minutes versus ≤30.0 minutes, aOR: 2.19, 95% CI: 1.56–3.09); and travel distance from home to DTU (>30 km versus ≤30.0 km, aOR: 2.31, 95% CI: 1.63–3.27). In the multivariable Cox regression, significant determinants of time to treatment included urban DTUs ([urban versus rural], adjusted hazards ratio (aHR): 0.72, 95% CI: 0.60–0.86); travel time from home to DTUs (>30 minutes versus ≤30.0 minutes, aHR: 0.80, 95% CI: 0.69–0.92); and travel distance from home to DTU (>30 km versus ≤30.0 km, aHR: 0.76, 95% CI: 0.66–0.89). In the prospective study, 1060 cases of bacteriologically confirmed TB were identified, and 10.6% (95% CI: 8.7–12.4%) had PLTFU. Risk factors for PLTFU and determinants of time to treatment in the prospective study were similar to those in the retrospective study. Major reasons for loss to follow-up included lack of transport money to get back to hospital (50%), DTU was too far away from home (29.3%), and 14.6% had travelled out of town. In the impact evaluation study, patient counseling and phone reminder was associated with reduced odds of PLTFU both in the univariable (odds ratio [OR]: 0.56; 95% CI: 0.44–0.72) and multivariable (OR: 0.61; 95% CI: 0.47–0.79) analysis. In the regression discontinuity analysis using logistic regression, the association between the intervention and PLTFU was not statistically significant (aOR: 0.71, 95% CI 0.25–2.01), and the associations for the linear time trend (aOR: 0.999, 95% CI 0.996– 1.002) per day; and for the interaction between intervention and time (aOR: 1.0001, 95% CI 0.996–1.005) were not significant either. Conclusion: Access to TB treatment following diagnosis was still a major problem in Cameroon. This may be hampered by risk factors related to the patients and the TB care providers. The presence of PLTFU introduced a significant barrier to TB control. Measures such as adequate pre-and post-diagnosis counselling and phone call reminders may have a positive effect on reducing PLTFU, but their effectiveness needs to be assessed in subsequent studies. | en |
dc.description.provenance | Made available in DSpace on 2021-05-12T09:35:14Z (GMT). No. of bitstreams: 1 ntu-107-D02849017-1.pdf: 9482154 bytes, checksum: 0e03b078758b3b959765d5ad147d5e6a (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | CERTIFICATION i
ABBREVIATIONS ii ABSTRACT iii TABLE OF CONTENTS 1 CHAPTER 1. BACKGROUND AND LITERATURE REVIEW 5 1.1 Global tuberculosis epidemiology and control 5 1.2 Pre-treatment loss to follow-up (PLTFU) 6 1.3 Literature review of pre-treatment loss to follow-up 6 1.3.1 Proportion of pre-treatment loss to follow-up 6 1.3.2 Determinants or risk factors for pre-treatment loss to follow-up 7 1.3.3 Patients’ reasons for pre-treatment loss to follow-up 8 1.3.4 Interventions directed towards ameliorating pre-treatment loss to follow-up 9 1.4 Tuberculosis prevention and care in Cameroon 9 1.5 Knowledge gaps. 11 CHAPTER 2. STUDY OBJECTIVES 12 2.1 Retrospective study objectives: 12 2.2 Prospective study objectives: 12 2.3 Impact evaluation of patient counselling and phone reminder study objectives: 13 CHAPTER 3. METHODS 14 3.1 Overview 14 3.2 Study population 14 3.3 Data collection and management 15 3.4 Measurement of pre-treatment loss to follow-up 17 3.5 Measurement of the determinants of pre-treatment loss to follow-up 17 3.6 Statistical analysis 18 3.6.1 Retrospective study 18 3.6.2 Prospective study 19 3.6.3 Impact evaluation of patient counselling and phone reminder study 19 3.7 Sample size and power estimation 20 3.8 Ethical clearance 21 CHAPTER 4. RESULTS 22 4.1 Retrospective study 22 4.2 Prospective study 23 4.3 Impact evaluation of patient counselling and phone reminder study 24 CHAPTER 5. DISCUSSIONS 26 5.1 Retrospective study: 26 5.2 Prospective study: 29 5.3 Impact evaluation of patient counselling and phone reminder study: 30 5.4 Implications for tuberculosis control in Cameroon and worldwide 31 CHAPTER 6. CONCLUSION 32 REFERENCES 34 Figures 37 Figure 1. TB diagnostic and care pathway 37 Figure 2. Location of Cameroon within Africa 38 Figure 3. Regions of Cameroon 39 Figure 4. Cameroon TB laboratory and treatment registers 40 Figure 5. Distribution of treatment delay by days among all bacteriologically-confirmed pulmonary tuberculosis patients diagnosed in the North West and South West Regions of Cameroon. 41 Figure 6. Geospatial distribution of tuberculosis diagnostic and treatment units (DTUs) and patients diagnosed within the North West (NW) and South West (SW) Regions of Cameroon. 42 Figure 7. Non-linear spline depicting the Odds Ratios of PLTFU and travel distance to DTU 43 Figure 8. Scatterplot showing the probability of PLTFU over time during the study period. 44 Figure 9. Probability of PLTFU over time during the study period and the predicted probability with 95% confidence bands from the univariable logistic regression model of the intervention and PLTFU. 45 Figure 10. Probability of PLTFU over time during the study period and the predicted probability with 95% confidence bands from the multivariable logistic regression model including the intervention, the linear term of time trend, and the interaction term of the intervention and time. 46 Tables 47 Table 1. TB incidence rate within Middle African region, 2012. 47 Table 2. General characteristics of retrospective study population 48 Table 3. Comparison of characteristics of patients with PLTFU to those who accessed antituberculosis treatment within 7 days of diagnosis in the retrospective study 49 Table 4. Factors associated with PLTFU in patients with bacteriologically-confirmed pulmonary tuberculosis: Univariable and Multivariate Logistic Regression Analyses in the retrospective study 7 days post-diagnosis (n=1112) 50 Table 5. Factors associated with PLTFU in patients with bacteriologically-confirmed pulmonary tuberculosis: Univariable and Multivariate Cox Proportional Hazards Regression Analyses in the retrospective study after 30 days follow-up (n=1112) 51 Table 6. General characteristics of the prospective study population (N=1060) 52 Table 7. Comparison of characteristics of patients with PLTFU to those who accessed anti-tuberculosis treatment within 7 days of diagnosis in the prospective study (N=1060) 54 Table 8. Factors associated with PLTFU in patients with bacteriologically confirmed pulmonary tuberculosis: Univariable and Multivariate Logistic Regression Analyses in the prospective study, 7 days post-diagnosis (n=1060) 56 Table 9. Factors associated with PLTFU in patients with bacteriologically confirmed pulmonary tuberculosis: 58 Univariable and Multivariate Cox Proportional Hazards Regression Analyses in the prospective study after 30 days follow-up (n=1060) 58 Table 10. Reasons for PLTFU from patients in the prospective study population 60 Table 11. General characteristics of the impact evaluation study population 61 Table 12. Univariable and Multivariate Logistic Regression Analyses of PLTFU for the impact evaluation study, 7 days post-diagnosis (n=2160) 62 Table 13. Univariable and Multivariate Cox Proportional Hazards Regression Analyses of PLTFU for the impact evaluation study after 30 days follow-up (n=2160) 63 APPENDICES 64 Publication 64 Letter of acceptance 82 ANNEXES 84 1. Participant’s information notice 84 2. Informed consent 86 3. Questionnaires 88 4. Ethical approval letters 93 | |
dc.language.iso | en | |
dc.title | 喀麥隆細菌學陽性肺結核患者的治療前失落調查 | zh_TW |
dc.title | Pre-treatment Loss to Follow-up of Bacteriologically confirmed Pulmonary Tuberculosis Patients and Its Determinants in Two Regions of Cameroon | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-1 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 詹長權(Chang-Chuan Chan),陳為堅(Wei-J Chen),方啟泰(Chi-Tai Fang),江振源(Chen-Yuan Chiang) | |
dc.subject.keyword | TB,travel-time,travel distance,pre-treatment loss to follow-up,initial default,risk factors, | zh_TW |
dc.relation.page | 97 | |
dc.identifier.doi | 10.6342/NTU201800575 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2018-02-14 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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