Thesis ( MPH.) -- University of Limpopo, 2022 / Background
Multidrug-resistant tuberculosis (MDR-TB) has recently resulted to be in an
emergence state globally and this of constitute a big challenge for TB control and the
goals of the World Health Organization’s End TB Strategy. Aminoglycosides (AG)
were often used as part of treatment of life-threatening illnesses such as MDR-TB for
decades, however their adverse effects are widely described and hearing loss is one
of the major side effects. The risk factors for hearing loss in patients treated with AG
include the dose and duration of AG, infection with human immunodeficiency virus
(HIV), older age and persons exposed to a high level of noise while the damage can
be total and permanent. Severe hearing impairment has been reported to occur among
patients treated for MDR-TB with injectable drugs, especially among the elderly and
patients infected with human immunodeficiency virus, however, Bedaquiline containing regimens have demonstrated improved outcomes over injectable containing regimens in the long-term treatment of MDR-TB.
Methods
The objective of the current study was to investigate the burden of hearing loss
amongst MDR-TB patients on bedaquiline at Zithulele Hospital in Eastern Cape
Province. Therefore, the current study followed a quantitative retrospective approach
using simple random sampling to select MDR-TB patients treated with bedaquiline and
having a baseline audiogram be the initiation of treatment. The data was captured in
a Microsoft Excel spreadsheet and then transferred to Statistical Package for Social
Sciences (SPSS) Version 20 for data analysis in which categorical variables were
presented as percentages and frequencies, while continuous variables was presented
as mean, median and standard deviation lastly, comparison of categorical variables
was done using a Chi-Squared test, whereas continuous variables were compared
using a t-test. P-value of <0.05 will be considered significant.
Results
The mean age for the participants was 39.2 years with standard deviation of 11.8 and
there was no statistical significance difference between the age groups (p value =
0.178). There no was a statistical significance difference between the employment
status (p value = 0.794), previous use of injectables (p value = 0.360) and type of
hearing of loss (p value = 0.536). Majority of the MDR-TB patients on bedaquiline did
not have hearing loss at 67% while those who had gradual hearing loss and sudden
hearing loss were 26.8% and 6.2% respectively. There was no statistical significance
difference between males and females in both the right and left ears, however, the
right ear results appeared to be slightly worse than the left ear results. It was found
that both males and females had a high frequency hearing loss in the left ears of 26.8%
and 22.2% respectively as compared to the right ears with of 25.9% and 1.6%
respectively. The was a statistical significance difference between the age groups in
both ears for hearing loss at p-value <0.001.
The overall prevalence of hearing loss was found to be 32.9% and hearing loss at
20dB or more loss at any frequency was low at 11.9% while hearing loss at 10B or
more loss at any frequency was the highest at 32.9% followed by loss response at 3
consecutive frequencies at 26.2%. Hearing loss was increasing with increasing age
from 8.3% in age group and age was significantly associated with hearing loss as older
patients were 2.2 times more likely to have a hearing loss at a degree of 20dB and 4.4
times more likely to have a hearing loss at a degree of 10dB. Previous use of
injectables was also significantly associated with hearing loss as patients who used
injectables previously were 11.5 times more likely to have a hearing loss at degree of
10dB, 5.6 and 11.3 times more likely to have a hearing loss at loss response at 3
consecutive frequencies and overall hearing loss respectively.
Conclusion
South Africa has a high burden of drug-resistant tuberculosis (DRTB) and until
recently, ototoxic aminoglycosides were predominant in treatment regimens. Drug resistant TB treatment with bedaquilines caused clinically and statistically significant
deterioration of hearing loss in patients, most prominently at high frequencies.
Although public health interventions to prevent hearing loss have been deemed cost effective and have meaningful individual and economic implications, hearing loss and
its prevention consistently receive inadequate attention as a global public health
priority. Despite the serious impacts of hearing loss, little is known regarding
prevalence of ototoxic hearing loss after treatment for DR-TB. Therefore, when the
use of injectable ototoxic medications is unavoidable, audiological ototoxicity
monitoring is essential to optimise hearing-related outcomes.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/4208 |
| Date | January 2022 |
| Creators | Matikinca, Sibulele |
| Contributors | Maimela, E. |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | xii, 41 leaves |
| Relation |
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