الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Tuberculosis remains a major problem to health care and despite the high rates of successful treatment outcome (cure and treatment completion), the rates of unfavorable outcomes (failures, defaulters, deaths) remains high. So monitoring the tuberculosis treatment outcomes and analyzing the responsible factors for unsuccessful treatment is very important to evaluate the effectiveness and efficiency of TB intervention programs.
The present study was conducted in two chest dispensaries in Alexandria. A sample size of 400 medical records of TB patients who visited the selected dispensaries during the period from 2005 to 2015 was reviewed and a check list was designed based on variables in the TB treatment cards of the patients for data collection.
The proportion of TB cases in each dispensary was calculated in each year from 2005 to 2015. In El-Kabbary chest dispensary the proportion was decreased from 34 per 10000 populations in 2005 to 19 per 10000 populations in 2015. In Moharrem Bey Chest dispensary the proportion was decreased from 45 per 10000 populations in 2005 to 18 per 10000 populations in 2015.
For the survival analysis, the analysis was done 5 times, and each outcome of the 5 treatment outcomes was considered separately as the event of interest, these outcomes were cured, completed treatment, failure, defaulter and death.
A univariate descriptive statistics analysis was conducted using Kaplan -Meier (KM) method to estimate overall survival and to compare the survival curves we used the log‑rank test, while the Cox proportional hazard model was used for the multivariate analysis to determine possible association of predictor variables to the event.
Follow-up ranged from 4 days to 311 days with a mean of 185.48 days, Male patients were 275 (68.8%), while female patients accounts for 125 (31.2%), and their age ranged between 15 and 85 years (mean37.36± 14.6years). About half of them (54.2%) range from 21 to 40 years old. And their marital status showed that a total of 187 (46.8%) patients were married, 196 (49.0) were single, 17 (4.2%) were Widowed or Divorced and 113 (28.3%) were employed while 287 (71.7%) were unemployed.
As regards comorbidities, about 14% of patients had DM, 12.3% of patients had Hypertension, 6% had heart diseases, 1.8% had liver cirrhosis, 1.3% had chronic obstructive pulmonary diseases, 0.8% had renal failure and only 0.5% had Cancer.
Treatment outcomes was distributed as following, 59.8% cured, 22.5% completed treatment, 10.3% death, 4.4% defaulter and 3% treatment failure.
The minimum follow up time was 4 days and the maximum was 311days.
For the outcome cure, the median survival time was 194 days and the 6 Month survival rate was 90%.
For the outcome completed treatment, the median survival time was 292 days, and The 6 Month survival rate was 89%.
For treatment failure the mean survival time was 304 days and the 6 Month survival Rate was 96%, for treatment default the mean survival time was 292 days, and The 6 Month survival Rate was 96%, and for death the mean survival time was 287 days, and The 6 Month survival Rate was 90%.
According to the cox regression model results, the cure rate was higher among males, smear (+ve) PTB, patients without comorbidities, and relapsed patients.
The treatment completion rate was higher among EPTB patients and patients with normal x-ray, also the treatment default rate was higher among Patient category defaulters than new. Type of TB, Chest radiographic presentation and history of comorbidities; heart disease, renal failure and liver cirrhosis were risk factors for higher death rate.
6.2. Conclusion
from the current study we conclude the following:-
1. There was a decrease in the total number of TB cases across the studied years
2. TB in this study was found to affect the most productive age groups and this needs more attention in TB control programs
3. TB rate was higher in the male population than in the female population and in unemployed than employed patients
4. treatment success rate of TB patients in this study was encouraging
5. death rate in this study was slightly high
6. treatment failure rate was 3% & default rate was 4.4% in this study
7. type of TB, heart disease and patient category were significantly associated with time to cure of tuberculosis patients
8. PTB, abnormal chest radiographic presentation and comorbidities were significantly associated with time to death
9. previously defaulted history was significantly associated with time to treatment default
6.3. Recommendations
Based on the study findings and conclusion, the following recommendations are suggested:
1. Frequent supportive supervision for patients with a high risk of unsuccessful treatment outcomes should be carried out
2. Regular health education programs should be done with focusing on removing the TB stigma and encouraging patients to seek medical advice
3. Find ways to improve the immunity of the patients to avoid co-infection with COVID 19
4. Better recording of cases for completeness of the registry which is a common problem in practice
5. Implementation of electronic medical records system.
6. Further studies are needed to identify other potential socio demographic and behavioral factors that could affect the treatment outcomes of TB patients.