PhD / Department of Public Health / See the attached abstract

This quantitative, descriptive study investigated risk factors for MDR-TB in Addis Ababa, Ethiopia. A total of 439 medical records belonging to MDR-TB and non MDR-TB patients managed in public health centres from January 2008 to December 2011 were analysed. Data were transcribed from each TB patient‟s medical records using a specifically designed checklist. The findings revealed that male gender, previous history of TB treatment, poor treatment adherence, an outcome of failure after TB re-treatment, previous category of failure, pulmonary involvement of TB infection and HIV infection were associated with MDR-TB. The findings illustrate that efforts should be made to prioritise the development and implementation of effective MDR TB screening and treatment protocols for these high risk groups to improve treatment outcome and minimize the emergence of XDR TB. / Health Studies / M. Public Health

Text in English with questionnaire in Amharic / Purpose: The purpose of the study was to evaluate the effectiveness of the tuberculosis directly observed treatment, short-course (DOTS) strategy with respect to patient centeredness and satisfaction, and propose a model in support of the DOTS strategy in Addis Ababa, Ethiopia. Method: The study was conducted in Addis Ababa, Ethiopia using a mixed-method approach. An interviewer-administered questionnaire was used to collect quantitative data from 601 randomly selected TB patients who were on TB treatment followup in 30 health facilities.Three focus group discussions were conducted with 23 TB experts purposefully selected from 10 sub-city health offices and health bureau. Moreover, telephonic interviews were conducted with 25 defaulted TB patients who had been attending TB treatment in the health facilities. The quantitative data were described using mean, median, percentage and frequencies. Logistic regression and exploratory factor analysis were used to extract associated factors using SPSS version 21 software. Thematic analysis was used for qualitative data analysis. Deductive and inductive reasoning was used to propose a descriptive model with substantiating literatures. Findings: Of the 601 TB patients included, 40% of them perceived they had not received a patient-centred TB care (PC-TB care) with DOTS strategy. Gender (AOR=0.45, 95%CI 0.3, 0.7), good communication (AOR=3.2, 95%CI 1.6, 6.1), treatment supporter (AOR=3.4, 95%CI 2.1, 5.5) were associated with the perceived PC-TB care. Thirty-seven percent of TB patients were following their TB treatment with feeling of dissatisfaction with DOTS strategy. Gender (AOR=2.2; 95%CI 1.3, 3.57), place of residence (AOR=3.4; 95%CI 1.6, 7.6), presence of symptoms (AOR=0.6, 95%CI 0.40, 0.94) and treatment-supporter (AOR=4.3, 95%CI 2.7, 6.8) were associated with satisfaction of TB patients. TB experts and defaulted TB patients pointed out that DOTS strategy is not providing comprehensive PC-TB care except the provision of facility choice where to follow during initiation of the treatment. DOTS delivery system inflexibility, loose integration, HCPs’ characteristic, communication skill and motivation and the community awareness were explored factor with patient centeredness of DOTS. DOTS delivery system, incompatible of diagnosis and patient beliefs were the identified categories to default. The proposed PC-TB care model core constructs are patient, community, health care providers, health care organisation and TB care delivery system. The core constructs are directed by policy and monitoring and evaluation components. Conclusion: DOTS strategy is limited to provide fully integrated PC-TB care and did not provide full satisfaction to TB patients. Therefore, a support that makes the TB care patient-centred are important and the proposed PC-TB care model needs to be tested, practiced and evaluated for its performance toward increments of patient centeredness of TB care. / Health Studies / D.Litt. et Phil. (Health Studies)

This quantitative, descriptive study investigated risk factors for MDR-TB in Addis Ababa, Ethiopia. A total of 439 medical records belonging to MDR-TB and non MDR-TB patients managed in public health centres from January 2008 to December 2011 were analysed. Data were transcribed from each TB patient‟s medical records using a specifically designed checklist. The findings revealed that male gender, previous history of TB treatment, poor treatment adherence, an outcome of failure after TB re-treatment, previous category of failure, pulmonary involvement of TB infection and HIV infection were associated with MDR-TB. The findings illustrate that efforts should be made to prioritise the development and implementation of effective MDR TB screening and treatment protocols for these high risk groups to improve treatment outcome and minimize the emergence of XDR TB. / Health Studies / M.A. (Public Health)

A osteomielite possui elevada prevalência e morbidade. O tratamento depende de apropriada terapia antimicrobiana por tempo prolongado e frequentemente requer cirurgia para remoção de tecidos necróticos. A aderência dos pacientes com osteomielite à prescrição do antibiótico, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. O objetivo deste estudo foi mensurar a aderência à terapia antimicrobiana oral em pacientes adultos com osteomielite; identificar se alguns fatores relacionados na literatura estavam associados com a não aderência; estabelecer o valor preditivo dos fatores associados a não aderência ao tratamento em pacientes com osteomielite. Foi realizado um estudo transversal, fundamentado na avaliação por meio de métodos indiretos da aderência para 83 pacientes. Foram considerados pelo menos 30 dias de uso do antimicrobiano à entrevista e os pacientes foram classificados como aderentes de acordo com o questionário de Morisky, que é constituído por 4 questões com respostas dicotômicas para avaliar a aderência. Os pacientes com < 2 pontos foram considerados de baixa aderência e os que obtiverem > 3 pontos, de alta aderência. O presente estudo identificou uma prevalência de alta aderência de 83,1% (n=63). O ajuste dos modelos de regressão logística múltipla não resultou em variáveis conjuntas influenciando a aderência ao tratamento, porém pacientes do gênero masculino sugeriram apresentar maior frequência de baixa aderência ao tratamento em relação aos pacientes do gênero feminino (p = 0,053). Com relação à idade, a análise dos dados mostrou que os pacientes com idade entre 31 e 59 anos possuíam probabilidade de baixa aderência 68% menor que pacientes com idade entre 18 e 30 anos. A aderência observada foi semelhante à encontrada na literatura. Os fatores sociodemográficos podem interferir na aderência de pacientes em uso de antibióticos orais para tratamento de osteomielite / Osteomyelitis is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on appropriate antimicrobial therapy. Adherence of patients with osteomyelitis to the prescribed treatment, although critical for successful treatment, has been little studied. The aim of the study was: to measure the adherence to oral antimicrobial therapy in adult patients with osteomyelitis; to identify whether some of the factors listed in health literature were associated with non-adherence; to establish the predictive values associated with non-adherence to antimicrobial therapy in patients with osteomyelitis. We conducted a cross-sectional study, based on evaluation through indirect methods of adherence for 83 patients. We included patients receiving at least 30 days of antimicrobial use. Patients were interviewed and classified as adherent according to the Morisky questionnaire, that consists of 4 questions with dichotomous responses to assess adherence. Patients with 3 points, with high adherence. This study identified a prevalence of high adherence of 83.1% (n = 63). The multivariate logistic regression analysis did not result in multiple variables influencing adherence to treatment. Gender was the only variable with an suggested association with low adherence, male gender was more associated with low adherence than female (p = 0,053). Regarding age, data analysis showed that patients aged between 31 and 59 years had low adherence probability 68% lower than patients aged between 18 and 30 years. The high adherence observed in this study was similar than previous reported in the literature. Social and demographic factors may interfere in the adherence with patients using oral antibiotics for the treatment of osteomyelitis

A osteomielite possui elevada prevalência e morbidade. O tratamento depende de apropriada terapia antimicrobiana por tempo prolongado e frequentemente requer cirurgia para remoção de tecidos necróticos. A aderência dos pacientes com osteomielite à prescrição do antibiótico, embora fundamental para o sucesso terapêutico, tem sido pouco estudada. O objetivo deste estudo foi mensurar a aderência à terapia antimicrobiana oral em pacientes adultos com osteomielite; identificar se alguns fatores relacionados na literatura estavam associados com a não aderência; estabelecer o valor preditivo dos fatores associados a não aderência ao tratamento em pacientes com osteomielite. Foi realizado um estudo transversal, fundamentado na avaliação por meio de métodos indiretos da aderência para 83 pacientes. Foram considerados pelo menos 30 dias de uso do antimicrobiano à entrevista e os pacientes foram classificados como aderentes de acordo com o questionário de Morisky, que é constituído por 4 questões com respostas dicotômicas para avaliar a aderência. Os pacientes com < 2 pontos foram considerados de baixa aderência e os que obtiverem > 3 pontos, de alta aderência. O presente estudo identificou uma prevalência de alta aderência de 83,1% (n=63). O ajuste dos modelos de regressão logística múltipla não resultou em variáveis conjuntas influenciando a aderência ao tratamento, porém pacientes do gênero masculino sugeriram apresentar maior frequência de baixa aderência ao tratamento em relação aos pacientes do gênero feminino (p = 0,053). Com relação à idade, a análise dos dados mostrou que os pacientes com idade entre 31 e 59 anos possuíam probabilidade de baixa aderência 68% menor que pacientes com idade entre 18 e 30 anos. A aderência observada foi semelhante à encontrada na literatura. Os fatores sociodemográficos podem interferir na aderência de pacientes em uso de antibióticos orais para tratamento de osteomielite / Osteomyelitis is a highly prevalent disease and a major cause of morbidity. Clinical treatment is based on appropriate antimicrobial therapy. Adherence of patients with osteomyelitis to the prescribed treatment, although critical for successful treatment, has been little studied. The aim of the study was: to measure the adherence to oral antimicrobial therapy in adult patients with osteomyelitis; to identify whether some of the factors listed in health literature were associated with non-adherence; to establish the predictive values associated with non-adherence to antimicrobial therapy in patients with osteomyelitis. We conducted a cross-sectional study, based on evaluation through indirect methods of adherence for 83 patients. We included patients receiving at least 30 days of antimicrobial use. Patients were interviewed and classified as adherent according to the Morisky questionnaire, that consists of 4 questions with dichotomous responses to assess adherence. Patients with 3 points, with high adherence. This study identified a prevalence of high adherence of 83.1% (n = 63). The multivariate logistic regression analysis did not result in multiple variables influencing adherence to treatment. Gender was the only variable with an suggested association with low adherence, male gender was more associated with low adherence than female (p = 0,053). Regarding age, data analysis showed that patients aged between 31 and 59 years had low adherence probability 68% lower than patients aged between 18 and 30 years. The high adherence observed in this study was similar than previous reported in the literature. Social and demographic factors may interfere in the adherence with patients using oral antibiotics for the treatment of osteomyelitis