Management of Multi Drug-resistant Tuberculosis at Kenyatta National Hospital

Abstract

Literature has indicated existence of unprecedented spread of MDR/XDR TB associated with failure to complete TB treatment. Based on this, the study identified factors behind the outcomes of management of multi drug- resistant and extensively drug- resistant tuberculosis at Kenyatta National Hospital. The study made use of secondary data obtained from TB and MDR/XDR specialized clinic records at Kenyatta National Teaching and Referral Hospital which contains factors associated with management of multi drug- resistant and extensively drug- resistant tuberculosis. Specifically, the study sought to determine the demographic and socio-economic factors challenging the outcomes of management MDR/XDR TB patients at KNH, assess the common system deficiencies which affect the outcomes of management of MDR and XDR TB at KNH, and relate the treatment regimen and treatment duration on the treatment and outcomes of the management of MDR /XDR TB at KNH. The Linear Probability Model (LPM) has been used for estimation of the outcome models. The dependent variable used was TB management outcomes (treatment completion and MDR/XDR status), while the factors that affect outcome include age, sex, education levels of patient, marital status, residence, employment status, drug regimen, treatment duration, system deficiencies, distance and TB-HIV/AIDS co-infection . The study revealed that being married and living far from the MDR treatment centre increased the chance of completing treatment, while co-morbidities and other factors like relocation of patients, death of patients due to treatment complications, absconding from treatment and succumbing of patients to greater illness severity after admission negatively affected treatment completion. The study indicates a need for prior and immediate focus on rapid identification programmes of patients with MDR/XDR TB using the available technologies .It is also important to invest in developing new technologies to enhance diagnostics which match the developments in therapeutics or prevention. This is because the increased cases of patients succumbing upon being admitted to treat co-morbidities raises the likelihood of not completing treatment. There is a need to develop suitable tests for early diagnosis and ensuring availability of appropriate treatment for MDR/XDR-TB.