نوع مقاله : مقاله پژوهشی
نویسندگان
1 دانشیار گروه مدیریت و اقتصاد سلامت، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران
2 دانشیار، گروه آموزش بهداشت و ارتقای سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی خراسان شمالی، خراسان شمالی ، ایران
3 استاد، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشگاه علوم پزشکی مشهد، مشهد، ایران
4 دانشجو دکتری، مرکز تحقیقات بیماری های غیرواگیر، دانشگاه علوم پزشکی سبزوار،سبزوار، ایران. کمیته تحقیقات دانشجویی، دانشگاه علوم
چکیده
زمینه و هدف: سل بهعنوان یک چالش بهداشت عمومی قابلتوجه، بهویژه در مناطق با محدودیت منابع مانند ایران، ادامه دارد. در ایران، بروز سل، بهویژه در استانهای پرخطر مانند خراسان رضوی، بیش از میانگین کشوری است که نیاز به مداخلات فوری بهداشت عمومی دارد. بنابراین، این مطالعه باهدف بررسی برخی از عوامل مؤثر بر بهبودی و شکست درمان بیماران مبتلا به سل در خراسان رضوی طی سالهای 1401-1395 انجام شد.
مواد و روشها: این مطالعه مقطعی گذشته نگر با استفاده از دادههای جامع سیستم ملی ثبت سل طی سالهای 1401-1395 در خراسان رضوی انجام شد. تجزیهوتحلیلهای آماری، از جمله آزمون کایدو و رگرسیون لجستیک، برای ارزیابی روابط بین متغیرهای جمعیتشناختی و میزان مؤفقیت درمان استفاده شد.
یافتهها: در میان 2186 بیمار، میزان شکست درمان 1/2% بود. ارتباط آماری معنیداری با جنسیت، وضعیت تاهل، ملیت یا سطح تحصیلات مشاهده نشد. آزمون رگرسیون لجستیک نیز عامل پیشبینیکنندهی قابلتوجهی را برای نتایج درمان نشان نداد. بااینحال، بیشترین میزان شکست درمان در میان افراد مجرد (8/2%) و سطح تحصیلات بالاتر (0/3%) بود.
نتیجهگیری: این مطالعه بر ضرورت اجرای مداخلات متمرکز تأکید دارد تا عوامل اجتماعی تعیینکننده، از جمله ارائه حمایتهای ویژه به گروههای آسیبپذیر، موردتوجه قرار گیرد. تقویت برنامههای پیشگیری و کنترل سل، امری ضروری برای دستیابی به اهداف جهانی ریشهکنی این بیماری بهشمار میرود.
تازه های تحقیق
https://scholar.google.com/citations?user=dqlrAV0AAAAJ
https://www.ncbi.nlm.nih.gov/pubmed?term=Javad%20Moghri
https://scholar.google.com/citations?user=uRV6dbQAAAAJ
https://www.ncbi.nlm.nih.gov/pubmed?term=hamid%20joveini
https://scholar.google.com/citations?user=Ke11MjIAAAAJ
https://pubmed.ncbi.nlm.nih.gov/39586814/
https://scholar.google.com/citations?view_op=search_authors&mauthors=zahra+keyvanlo&hl=en&oi=ao
https://www.ncbi.nlm.nih.gov/pubmed?term=zahra%20keyvanlo
کلیدواژهها
موضوعات
عنوان مقاله [English]
Study of Some Factors Affecting Recovery and Treatment Failure of Patients with Tuberculosis in Khorasan Razavi: A Cross-Sectional Study (2016-2022)
نویسندگان [English]
- Javad Moghri 1
- Hamid Joveini 2
- Habibollah Esmaily 3
- Zahra Keyvanlo 4
1 Associate Professor، department of Health Management and Economics, School of Health, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
2 Department of Health Education and Health Promotion, Faculty of Health, North Khorasan University of Medical Sciences, North Khorasan, Iran. Sabzevar, Iran
3 professor, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
4 PhD Student, Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran. Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee.
چکیده [English]
Background: Tuberculosis continues to be a significant public health challenge, especially in resource-limited areas such as Iran. The incidence of tuberculosis in Iran, especially in high-risk provinces such as Khorasan Razavi, is higher than the national average, requiring urgent public health interventions. Therefore, this study aimed to investigate some factors affecting the outcomes of tuberculosis treatment in Khorasan Razavi during 2016-2022.
Materials and Methods: This retrospective cross-sectional study used comprehensive data from the National Tuberculosis Registration System during 2016-2022, and investigated factors affecting the recovery and treatment failure of patients with tuberculosis in this North-Eastern province. Statistical analyses, including chi-square and logistic regression, were used to assess the relationships between demographic variables and treatment success rates.
Results: Among 2186 patients, the treatment failure rate was 2.1%, with no statistically significant associations observed for gender, marital status, nationality, and education level. Logistic regression also revealed no significant predictors of treatment outcomes. However, treatment failure was highest among single individuals (2.8%) and those with higher education levels (3.0%).
Conclusion: This study highlights the need for targeted interventions to address social determinants, including specific support provision for vulnerable groups. Disruptions caused by the COVID-19 pandemic are likely to have contributed to reduced TB case detection and treatment adherence. Strengthening TB prevention and control programs are essential to achieve global goals for eradication of the disease.
کلیدواژهها [English]
- Risk factors
- treatment outcome
- tuberculosis
- Iran
- Hasani S, Abolhalaj M, Behmaneshnia M, Bastani P, Ramezanian M, Najafi B, et Specific Revenue of Iranian Medical Science Universities within 2001-2010. World Applied Sciences Journal. 2013;22(4):479-484. https://doi.org/10.5829/idosi.wasj.2013.22.04.71246.
- Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM, et al. WHO's new end TB strategy. Lancet. 2015;385(9979):1799-1801. doi: 10.1016/S0140-6736(15)60570-0.
- Tavanaee Sani A, Hajian S, Salehi M. Evaluation of PPD test in Medical Student of Mashhad University Medical Sciences in 2011-2013. medical journal of mashhad university of medical sciences. 2015;58(8):441-445. doi: 10.22038/mjms.2015.6175.
- Fukunaga R, Glaziou P, Harris JB, Date A, Floyd K, Kasaeva T. Epidemiology of Tuberculosis and Progress Toward Meeting Global Targets - Worldwide, 2019. MMWR Morb Mortal Wkly Rep. 2021;70(12):427-430. doi: 10.15585/mmwr.mm7012a4.
- Yoo IY, Lee J, Choi AR, Jun YH, Lee HY, Kang JY, et al. Comparative Evaluation of Standard E TB-Feron ELISA and QuantiFERON-TB Gold Plus Assays in Patients with Tuberculosis and Healthcare Workers. Diagnostics (Basel). 2021;11(9). doi: 10.3390/diagnostics11091659.
- Azeez A, Obaromi D, Odeyemi A, Ndege J, Muntabayi R. Seasonality and Trend Forecasting of Tuberculosis Prevalence Data in Eastern Cape, South Africa, Using a Hybrid Model. Int J Environ Res Public Health. 2016;13(8). doi: 10.3390/ijerph13080757.
- Doosti A, Nasehi M, Moradi G, Roshani D, Sharafi S, Ghaderi E. The Pattern of Tuberculosis in Iran: A National Cross-Sectional Study. Iran J Public Health. 2023;52(1):193-200. doi: 10.18502/ijph.v52i1.11682.
- Alavi SM, Enayatrad M, Cheraghian B, Amoori N. Incidence trend analysis of tuberculosis in Khuzestan Province, southwest of Iran: 2010-2019. Glob Epidemiol. 2023;6:100118. doi: 10.1016/j.gloepi.2023.100118.
- Cilloni L, Fu H, Vesga JF, Dowdy D, Pretorius C, Ahmedov S, et al. The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis. EClinicalMedicine. 2020;28:100603. doi: 10.1016/j.eclinm.2020.100603.
- Nazar E, Baghishani H, Doosti H, Ghavami V, Aryan E, Nasehi M, et al. Bayesian Spatial Survival Analysis of Duration to Cure among New Smear-Positive Pulmonary Tuberculosis (PTB) Patients in Iran, during 2011–2018. International Journal of Environmental Research and Public Health. 2021;18(1):54. doi: 10.3390/ijerph18010054.
- Kiani B, Raouf Rahmati A, Bergquist R, Hashtarkhani S, Firouraghi N, Bagheri N, et al. Spatio-temporal epidemiology of the tuberculosis incidence rate in Iran 2008 to 2018. BMC Public Health. 2021;21:1-20. doi: 10.1186/s12889-021-11157-1.
- Sharafi, M., Narouee, S., Rasoulizadeh, F. et al. Factors associated with survival of tuberculosis patients in Southeast Iran: comparison of stepwise cox regression, survival tree, and random survival forest. BMC Public Health 25, 3504 (2025). https://doi.org/10.1186/s12889-025-24603-1.
- Daneshi S, Mehni EB, Kamali M, Barfar E, Barahouei FB, Hushmandi K, et al. Prevalence and contributing factors of drug-resistant tuberculosis (DR-TB) in iran: a systematic review. BMC Infectious Diseases. 2025;25(1):1004. doi: 10.1186/s12879-025-11439-8.
- Kolifarhood G, Khorasani-Zavareh D, Salarilak S, Shoghli A, Khosravi N. Spatial and non-spatial determinants of successful tuberculosis treatment outcomes: An implication of Geographical Information Systems in health policy-making in a developing country. Journal of epidemiology and global health. 2015;5(3):221-230. doi: 10.1016/j.jegh.2014.11.00.
- Ayatollahi J, Halvani A, Khezri MG, Shahcheraghi SH. Treatment outcomes and influencing factors on patients with Pulmonary Tuberculosis: a retrospective study. Iberoamerican Journal of Medicine. 2021;3(2):105-108.org/10.5281/zenodo.4515506.
- Jimma W, Ghazisaeedi M, Shahmoradi L, Abdurahman AA, Kalhori SRN, Nasehi M, et al. Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis. Revista da Sociedade Brasileira de Medicina Tropical. 2017;50(03):287-295. doi: 10.1590/0037-8682-0002-2017.
- Nasehi M, Mirhaghani L. National TB Guidelines, National Technical Committee approved the struggle against tuberculosis. Department of health and Medical Education, central management of fighting contagious diseases.2nd Ed, 2010.
- United Nations . Transforming Our World: The 2030 Agenda for Sustainable Development 2017. https://sdgs.un.org/2030agenda.
- WHO Global tuberculosis report, 2019. Available: https://who.int/tb/publications/global_report/en/ [Accessed 07 Oct 2019].
- Chidambaram V, Tun NL, Majella MG, Ruelas Castillo J, Ayeh SK, Kumar A, et al. Male Sex Is Associated With Worse Microbiological and Clinical Outcomes Following Tuberculosis Treatment: A Retrospective Cohort Study, a Systematic Review of the Literature, and Meta-analysis. Clin Infect Dis. 2021;73(9):1580-1588. doi: 10.1093/cid/ciab527.
- Gilmour B, Xu Z, Bai L, Alene KA, Clements ACA. Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China. Trop Med Int Health. 2022;27(3):290-299. doi: 10.1111/tmi.13720.
- Dabitao D, Somboro A, Sanogo I, Diarra B, Achenbach CJ, Holl JL, et al. Sex Differences in Active Pulmonary Tuberculosis Outcomes in Mali, West Africa. Am J Trop Med Hyg. 2022;107 (2): 440-443. doi: 10.4269/ajtmh.21-1141.
- Konski A, Desilvio M, Hartsell W, Watkins-Bruner D, Coyne J, Scarantino C, et al. Continuing evidence for poorer treatment outcomes for single male patients: retreatment data from RTOG 97-14. Int J Radiat Oncol Biol Phys. 2006;66(1):229-233.org/10.1016/j.ijrobp.2006.04.005.
- Niu D, Tang H, Chen F, Zhao D, Zhao H, Hou Y, et al. Treatment failure and associated factors among people living with HIV on highly active antiretroviral therapy in mainland China: A systematic review and meta-analysis. PLoS One. 2023;18(5):e0284-405. doi: 10.1371/journal.pone.0284405.
- Nega J, Taye S, Million Y, Rodrigo C, Eshetie S. Antiretroviral treatment failure and associated factors among HIV patients on first-line antiretroviral treatment in Sekota, northeast Ethiopia. AIDS Res Ther. 2020;17(1):39. doi: 10.1186/s12981-020-00294-z.
- Wen S, Yin J, Sun Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMJ Open. 2020 Oct 8;10(10):e036985. doi: 10.1136/bmjopen-2020-036985. PMID: 33033087; PMCID: PMC7545632.
- Chen B, Peng Y, Zhou L, Chai C, Yeh HC, Chen S, Wang F, Zhang M, He T, Wang X. Social support received by multidrug-resistant tuberculosis patients and related factors: a cross-sectional study in Zhejiang Province, People's Republic of China. Patient Prefer Adherence. 2016 Jun 13;10:1063-70. doi: 10.2147/PPA.S105655. PMID: 27358557; PMCID: PMC4912324.
- Abdi M, Heidary M, Mirzaei R. Iran and the Challenge of Afghan Immigrants and Refugees With Tuberculosis. Health Secur. 2023;21(4):329-330. doi: 10.1089/hs.2023.0062.
- Ryuk DK, Pelissari DM, Alves K, Oliveira PB, Castro MC, Cohen T, et al. Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records. BMC Infect Dis. 2024;24(1):531.org/10.1186/s12879-024-09417-7.
- Gatete G, Njunwa KJ, Migambi P, Ntaganira J, Ndagijimana A. Prevalence and factors associated with sputum smear non-conversion after two months of tuberculosis treatment among smear-positive pulmonary tuberculosis patients in Rwanda: a cross-sectional study. BMC Infect Dis. 2023;23(1):408. doi: 10.1186/s12879-023-08395-6.
- World Health Organization. Pulse survey on continuity of essential health services during the COVID-19 pandemic. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1.
- Hogan AB, Jewell BL, Sherrard-Smith E, Vesga JF, Watson OJ, Whittaker C, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. The Lancet Global Health. 2020;8(9):e1132-e1141. doi: 10.1016/S2214-109X(20)30288-6.
- World Health Organization. Global tuberculosis report 2020. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/teams/global-tuberculosis-programme/tb-reports.
)