TUBERCULOSIS

(Factors that influences successful treatment of Tuberculosis)

 Name of Student: Reshma Mohabeir

 Name of the course (year and date): Public Health Management 2022/June
 Faculty Name: College of Public Health
 Student ID# (No name): GY_00453

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CONTENT PAGE
TOPICS PAGE NO.
Executive summary …………………………………………………………….. 2-3
Method…………………………………………………………………………….4
Data Analysis…………………………………………………………………….5
Result……………………………………………………………………………...6
Research Methodology………………………………………………………….7
Main Findings……………………………………………………………………8
Conclusion……………………………………………………………………….9
Introduction……………………………………………………………………...10
Analysis…………………………………………………………………………..11-12
Discussion……………………………………………………………………….13-15
Question 2……………………………………………………………………….16
Question 3……………………………………………………………………….17
Question 4……………………………………………………………………….18
Question 5……………………………………………………………………....19
Question 6……………………………………………………………………....20
Question 7………………………………………………………………………21
Limitations……………………………………………………………………..22
Conclusion……………………………………………………………………..23
Recommendations……………………………………………………………..24
References……………………………………………………………………...25

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EXECUTIVE SUMARRY
Aim/Objective: What are the factors that influences the successful treatment of
tuberculosis?
There were 399 PTB patients included in the study. Treatment by pulmonologists
(OR 1.93), receiving directly observed therapy (DOT) (OR 1.76), and receiving care
at the chest hospital were all factors that were significantly linked to successful
treatment (OR 5.41). Patients of advanced age were less likely to achieve treatment
success (OR 0.97). (OR 0.97). Those treated by pulmonologists at the chest hospital
had a treatment success rate that was significantly greater than that of patients
treated at other facilities (94.1% vs. 69.9%). Family support, socioeconomic,
physician and nurse support, availability to access health services, social stigma,
psychological stress, and knowledge were significant factors of the successful
treatment of tuberculosis. For future research, the interventions to promote the
program for decreasing the occurrence of the recurrent tuberculosis in the
community need to consider these factors for the successful treatment of
tuberculosis and collaborates with tuberculosis patients, family and health service
for development of appropriate intervention.
Main research questions
1. Describe the roles biostatistics serves in the discipline of public health?

2. What proportion of patients was successfully treated?

3. Calculate a 95% Confidence Interval (CI) for the true population proportion with
successful treatment. Hint: The SE of p is the square root of (pq)/n.

4. Write a sentence that describes the meaning of the 95% CI.

5. Using the information from Table 1, construct a 2x2 table to test the association between
DOT status and successful treatment.

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6. Generate the expected values for the empty cells below. Hint: the expected value for any cell
is the row total x column total divided by the grand (overall) total.

6. Given these expected values, is the chi-square test an appropriate statistical test?

7. Which of the following would be an appropriate approach to the analysis of these data?
Yes No A. Fisher’s Exact Test using all data
Yes No B. Chi-square or Fisher’s Exact testing after deleting unknowns

Method- In southern Taiwan, where the only chest

specialty hospital dedicated to specialized thoracic

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disease care, primarily for TB, is located, we conducted a population-based medical record
review. Hospitals and primary practitioners that provided TB care in the same region were
selected as comparative care providers. Tainan County, Tainan City, Chiayi County, and all of
these are study regions. As mandated by law in Taiwan, all suspected and confirmed TB cases
must be reported in a timely manner to the national computerized registry maintained by the
Taiwan Center for Disease Control (CDC). Reporting of cases has been encouraged and
reinforced through the implementation of a no-notification, no-reimbursement policy and a
notification-for-fee policy since 1997. We requested data on all suspected and confirmed TB
patients residing in the studied areas and recorded in the registry for the period 1 January to 30
June 2003. The study team, including four registered nurses (each with a minimum of 6 years’
clinical experience), two head nurses (each with a minimum of 12 years’ clinical experience) and
one pulmonologist had undertaken a series of training courses aimed to assure adequate
validation of data consistency. Site visits were planned in order to review each patient's medical
file, as well as the 15-month follow-up of medical records following the start of treatment.

Data Analysis- Bivariate analyses with 2 tests were used to compare differences in proportions
of dichotomous and categorical variables, which extracted
potential predictors of successful treatment. We then
performed multivariate logistic regression analyses on the
potential predictors with P < 0.10 obtained from bivariate
analyses. We constructed a full model that included all the
potential predictors identified through bivariate analyses
and then applied the forward substitution model building procedure to construct a reduced model
in which all the predictors were statistically significant. Odds ratios (ORs) and 95% confidence
intervals (CIs) of dichotomous and categorical risk variables on the binary outcome variables

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were calculated. All analyses were conducted using SPSS 10.0 software (SPSS Inc, Chicago, IL,
USA), and all the tests were performed at the two-tailed significance level of 0.05.

Result:
399 PTB individuals were enrolled in the trial. Successful treatment was strongly associated with
receiving care from pulmonologists (OR 1.93), receiving directly observed therapy (DOT) (OR
1.76), and going to the chest hospital. Patients were less likely to succeed with treatment if they
were older patients (OR 0.97). Individuals treated by pulmonologists at the chest hospital had a
treatment success rate that was significantly greater than that of patients treated at other facilities
(94.1% vs. 69.9%).

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Research methodology-
For at least the first two months of therapy, a health professional or other trained someone who
is not a family member watches as the patient takes anti-tuberculosis medications. This is known
as direct observed treatment (DOT). 1 DOT thereby moves the responsibility for cure from the
patient to the health care system. TB is treated in Taiwan using WHO-recommended regimens,
whether or not the patient is receiving DOT; the initial phase lasts for 2 months and consists of
isoniazid (H), ethambutol (E), rifampicin (R), and pyrazinamide (Z), followed by a 4-month
continuation phase that consists of H, E, and R (2HERZ/4HER).

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Main Findings-

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Table 1 Characteristics of 399 patients with PTB and univariate analyses of potential predictors
of successful treatment in the table above it was clearly shown that the percentage of successful
treatment was more prominent in Females.

Conclusion-

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 A higher treatment success rate was reported in individuals treated with DOT and by
pulmonologists, notably at the chest hospital. Hence, DOT and the education of healthcare
providers and organizations have a significant role in the success of TB treatment. Potential
predictors of successful treatment were extracted using bivariate analyses with two tests,
followed by multivariate logistic regression analyses with P 0.10. Odds ratios and 95%
confidence intervals were calculated using SPSS 10.0 software.

Introduction

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Biostatistics is a vital and invaluable tool for developing public health initiatives and
policies in the field of public health in general. Although having a big impact on public
health, biostatistics isn't always employed for anything other than data analysis.
Biostatistics is useful in determining the transmission and risk of spreading diseases in
addition to establishing demographic data, such as the number of infected and carriers
of diseases. This information allows public health professionals to decide on the most
effective interventions to stop further transmission and improve the survival rate
among the infected group.

ANALYSIS

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Issue to be solved: What Factors influences the successful treatment of infectious pulmonary
tuberculosis
Age, education, employment status, gender, and race and ethnicity have all been linked to
treatment completion. Age, education level, and employment have all been shown to increase
the likelihood of finishing treatment in general. (2013).

Family support
Family support is one of the elements that can influence adherence of tuberculosis patients in
undergoing the treatment procedure and result in recurrent disease. Family support can include
motivation for tuberculosis patients to undergo treatment, become drug supervisors in providing
support in accessing health services to get anti-tuberculosis drugs (Irnawati et al., 2016;
Nugroho et al., 2016; Retni & Sugiyanto, 2010; World Health Organization, 2013). If poor
family support can lead to failure in treatment and recurrent tuberculosis, it can lead to an
increasing severe prognosis of the disease. However, different things are expressed by
Wijayanti and Khusnal (2010) that family support in the form of parental behavior has no
significant relationship with the quality of life of children suffering from tuberculosis. This is
because of the child's perception of the disease he/she suffered.
Social stigma
Social stigma is one of the elements that can impact the course of tuberculosis treatment and
cause relapses. Gao et al. (2015) indicated that most tuberculosis patients will hide their
sickness and refuse to take regular treatment according to their fears about their neighbors who
will isolate and stay away from them when they discover they have tuberculosis. According to
Smit et al. (2011), knowing someone who is receiving treatment for tuberculosis will cause
social stigma, and because the disease is viewed as contagious, most people will avoid those
who have it. The stigma that arises in the community is often related to a person's level of
knowledge related to tuberculosis and its treatment Gao et al. (2015).

Enabling Factor
Physician and nurse support
Patients with tuberculosis who endure withdrawal treatment that is sometimes caused by lack of
support from physicians, nursing staff, and other caregivers in the treatment facilities (Tupasi et

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al., 2016). Lack of support from physicians and nurses is due to the lack of numbers of
tuberculosis nurses who really understand the tuberculosis treatment process (Bothamley et al.,
2011). (Bothamley et al., 2011). When delivering information / counseling about the treatment
and side effects produced by the treatment to be administered as well as when providing DOTS
services, a doctor's and nurse's support can be seen in their positive attitudes and actions.
Patients with tuberculosis are less compliant in undergoing treatment as a result of the
unfriendly attitudes of the medical and nursing staff (Ibrahim et al., 2014). Most tuberculosis
nurses are also drug supervisors who provide motivation to patients with tuberculosis during
treatment. Their activity is closely correlated with the degree of treatment compliance among
tuberculosis patients (Dimas et al., 2016). The success of the treatment of tuberculosis and the
occurrence of recurrent tuberculosis rate reduction can be achieved when there is a positive
response from the public health service for the handling of tuberculosis in the community
(Tesfahuneygn et al., 2015).

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DISCUSSION
This integrative review indicates major factors which related to the successful treatment of
tuberculosis and the incident of recurrent tuberculosis among tuberculosis patients of a
socioeconomic, availability to access health services, knowledge, psychological stress, family
support, social stigma, and physician and nurse support. From the results of the review of the
above article it can be concluded that factors that are closely related to the success of
tuberculosis treatment and the occurrence of recurrent tuberculosis are socioeconomic,
knowledge, family support, and physician and nurse support. From a socioeconomic
perspective, many people with tuberculosis argue that if they are taking treatment for
tuberculosis, they will take up their work time, so they get sanctions related to the overly
licensing process or lack of opinion on the day they are in control of their tuberculosis (Herrero
et al., 2015; Karyadi et al., 2002). In addition, socioeconomic is also closely related to
availability to access health service, where the availability of access to closer health services
and affordability can save their expenses and facilitate them to access health services, especially
tuberculosis treatment services (Herrero et al., 2015; Ibrahim et al., 2014; Kirana et al., 2016;
Tesfahuneygn et al., 2015). Herrero et al. (2015) suggest that with the problems associated with
the distance and ease of transport, hence the need for decentralization of tuberculosis health
services, making it more affordable and more accessible to people with tuberculosis. One other
dominant factor is knowledge as one of the domains forming one's behavior. This knowledge is
not only the knowledge of tuberculosis sufferers but also the family's knowledge of tuberculosis
and its treatment process. With good knowledge of the tuberculosis treatment process, the
family can provide good family support, perform the duties as the supervisor of taking
medicine, and reduce the stigma that arise within the family (Irnawati et al., 2016; Nugroho et
al., 2016; Retni & Sugiyanto, 2010; World Health Organization, 2013).
In addition, understanding of tuberculosis and its treatment process is also crucial to the
community with the objective of an active role in avoiding the spread of tuberculosis and giving
support for tuberculosis treatment in its surroundings (Gao et al., 2015). (Gao et al., 2015).
Physician and nurse support are also an important factor in the success of tuberculosis
treatment. This is because their activity in providing information/ counseling associated with
tuberculosis and treatment process, especially in terms of side effects DOTS, is needed by
patients with tuberculosis so they can undergo treatment without worrying about side effects

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and know how to deal with side effects of DOTS consumed (Pongoh et al., 2015; Tupasi et al.,
2016). (Pongoh et al., 2015; Tupasi et al., 2016). The less friendly attitude of physician and
nursing staff causes patients with tuberculosis not to continue the treatment process that they
are undergoing (Ibrahim et al., 2014). (Ibrahim et al., 2014). In addition, the lack of physician
and nursing staff support is also due to a lack of physicians and nursing staff who understand
tuberculosis and its treatment process (Bothamley et al., 2011).

Table 2 Multiple logistic regression for factors affecting the successful treatment of infectious
PTB 

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Table 3 Comparison of outcome of care by pulmonologists at the chest hospital and at the other
health care institutions 

Table 4 Multiple logistic regression for factors affecting the successful treatment of infectious
PTB 

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2. Calculate a 95% Confidence Interval (CI) for the true population proportion with
successful treatment. Hint: The SE of p is the square root of (pq)/n.

Sex Patients Successful Rate of Successful

(n) Treatment (n) Treatment (%)
Male 293 198 68%
Female 106 77 73%
Total 399 275 69%
Cases

95% Confidence Interval (CI) for the true population proportion with successful
treatment.
p̂ +/- z* (p̂ (1 - p̂ )/n)0.5.
Where z* = 1.96 (95% CL) p
= 275/399
p̂ = 0.69
(p̂ (1 - p̂ )/n) 0.5= (0.69(1-0.69)/399)0.5 = (0.69(0.31)/399)0.5 =0.023
Margin of error = 1.96*0.023154= 0.045381
0.1 +/- 0.045381= 64.462% to 73.538%

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3. Write a sentence that describes the meaning of the 95% CI.
I estimate with 95% confident that the true population proportion of successful
treatment is somewhere in the range of 64.462% to 73.538%.

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4. Using the information from Table 1, construct a 2x2 table to test the association between
DOT status and successful treatment.

Observed Treatment Successful treatment

DOT YES NO Total
YES 186 64 250
NO 86 60 146
UNKNO 3 0 3
WN
Table no. 5 Total 275 124 339 showing
association between DOT status and successful treatment

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5. Generate the expected values for the empty cells below. Hint: the expected value for any
cell is the row total x column total divided by the grand (overall) total.

Expected Treatment Success Value

DOT YES NO Total
YES 250*275/399=172 250*124/399=78 250
NO 146*275/399=101 146*124/399=45 146
UNKNO 3*275/399=2 3*124/399=1 3
WN
Total 275 124 339
Table 6 showing expected values for treatment success

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6. Given these expected values, is the chi-square test an appropriate statistical test?

Given these expected values, the chi-square test is an appropriate statistical test

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 7. Which of the following would be an appropriate approach to the analysis of these
data?

1. Yes No A. Fisher’s Exact Test using all data

2. Yes No B. Chi-square or Fisher’s Exact testing after deleting unknowns

Answer: Yes, No B. Chi-square or Fisher’s Exact testing after

deleting unknowns

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Limitations
Limitations of this study are the terminology employed in seeking and explaining the current
literature. The research literature is limited to journal articles obtained from four search engines,
EBSCO, PubMed, Direct Sciences and Google Scholar, which results in insufficient sampling
probability. This study also was limited only to seven factors that can influence the success of
tuberculosis treatment, so that it does not rule out the possibility of other factors that can also
influence the success of tuberculosis treatment.

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CONCLUSION
The most important factor that must be considered to provide health promotion action among
tuberculosis patients doing tuberculosis treatment were socioeconomic factors and knowledge of
tuberculosis disease and treatment. Every health professional is expected to pay attention to the
variables that can affect the outcome of tuberculosis treatment after reading this research study.

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Recommendations:
1. 1. I strongly advise using the 4-month course of rifapentine and moxifloxacin. This TB
treatment regimen is as effective as (noninferior to) the standard daily 6-month regimen
in curing drug-susceptible TB disease. Must be administered completely within 70 days
from treatment initiation.
2. They could have also used the first line of treatment such as isoniazid, a rifamycin
(rifampin or [less frequently] either rifapentine or rifabutin), pyrazinamide, and
ethambutol; in addition, moxifloxacin is a first-line agent when administered in
combination with isoniazid, rifapentine, and pyrazinamide.

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References
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Chapman, A. L. (2011). Tuberculosis in UK cities: workload and effectiveness of tuberculosis
control programmes. BMC Public Health, 11(1), 896.
https://doi.org/10.1186/1471-2458- 11-896

Cooper, H. M. (1998). Synthesing research: A guide for literature reviews Thousand Oaks,
California: Sage

Dimas, S. B., Sukartini, T., & Hidayati, L. (2016). Drugs supervisor activeness correlated with
motivation and tuberculosis medication adherence. Paper presented at the The 7th International
Nursing Conference, Surabaya

Dobler, C. C., Korver, S., Batbayar, O., Oyuntsetseg, S., Tsolmon, B., Wright, C., . . . Marais, B.
J. (2015). Success of community-based directly observed antituberculosis treatment in Mongolia.
The International Journal of Tuberculosis and Lung Disease, 19(6), 657- 662.
https://doi.org/10.5588/ijtld.14.0927

Gao, J., Berry, N. S., Taylor, D., Venners, S. A., Cook, V. J., & Mayhew, M. (2015). Knowledge
and perceptions of latent tuberculosis infection among Chinese immigrants in a Canadian urban
centre. International Journal of Family Medicine, 2015. https://doi.org/ 10.1155/2015/546042

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