Pre and Intra COVID-19ERA Comparison of Detection and Clinical Outcomes among Patients with Tuberculosis:A Four-Years Retrospective Follow-UP Study in Selected Public Hospitals in Addis Ababa, Ethiopia, 2023.
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Date
2023
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Addis Ababa University
Abstract
Background: Tuberculosis (TB) is still the biggest cause of death from an infectious disease
worldwide, with over 10 million people becoming infected each year. The coronavirus disease
2019 (COVID-19) outbreak has severely disrupted health-care systems and people's overall well-
being around the world. People with TB are more likely to develop severe disease or die than
people with COVID-19. The coexistence of COVID-19 with pulmonary TB can create a diagnostic
dilemma and additional diagnostic challenges for clinicians. Despite these difficulties, there is not
enough data to determine how COVID-19 affects TB patient detection and outcomes.
Objective: To compare the detection and clinical outcomes of patients with TB pre and intra
COVID-19 periods in selected public Hospitals of Addis Ababa, Ethiopia, 2023.
Methods: A retrospective observational follow-up study was undertaken among TB patients with
pre- and intra-COVID-19 era comparisons. This study was carried out in five public hospitals in
Addis Ababa, which were chosen using a stratified sample technique. A 1.2-structured ODK
version 2022 questionnaire was employed. Finally, it was exported to SPSS version 26 for analysis.
Bivariate analysis at a P-value of 0.25 and multivariable analysis at a P-value of 0.05 were applied
to announce for statistical significance
Results: Patients who had known treatment outcomes in the selected hospitals were 375 during
the COVID-19 period, compared with 469 TB during pre – COVID-19 period, showing a 20%
decline in TB testing. Despite the decrement of susceptible (10.6%) and rifampicin resistance (RR)
TB (47.7%), there was a 54.3% of multi-drug resistance (MDR) TB increment during the COVID-
19 period. Overall, there was significantly lower treatment success rate of TB during COVID-19
period (75.7% vs. 81.2%, p< 0.001), with higher rate of loss to follow up (8.8% vs. 6.2%, p=
<0.001) as well as death (12.8% vs. 8.7%, p= < 0.001) compared with pre-C0VID-19 period.
Factors such as treatment method in the pre-COVID-19 and age category, educational level, type
of tuberculosis, and HIV status during COVID-19 period were significant indicators of successful
TB treatment.
Conclusion and recommendation: COVID-19 had a substantial detrimental influence on overall
TB detection, RR-TB/MDR-TB, treatment success, lost-to-follow-up and mortality. To reduce the
impact on TB case detection, the TB program must rapidly adjust to the new normal, strengthen
patient-centered TB care, embrace digital health technology, increase awareness of generation,
and guarantee that other opportunities given by the pandemic will be utilized.
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Keywords
Tuberculosis, covid-19, Detection, clinical outcomes, Addis Ababa, Ethiopia