Loss to follow-up among patients diagnosed with spinal tuberculosis at a tertiary hospital in the Western Cape, South Africa : a retrospective cohort study
| dc.contributor.advisor | Dyers, Robin | en_ZA |
| dc.contributor.author | Mann, Theresa | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health. | en_ZA |
| dc.date.accessioned | 2019-02-21T06:41:16Z | |
| dc.date.accessioned | 2019-04-17T08:05:40Z | |
| dc.date.available | 2022-02-20T03:00:08Z | |
| dc.date.issued | 2019-02 | |
| dc.description | (Thesis (MPhil)--Stellenbosch University, 2022) | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY: Background: Patients diagnosed with spinal tuberculosis (TB) at a major tertiary hospital in the Western Cape are required to attend regular follow-up at the hospital’s outpatient spine clinic and to remain on TB treatment for at least 9 months. This follow-up and lengthy treatment is intended to allow for specialist monitoring of TB treatment response, early identification of secondary complications and reduced risk of recurrence. However, little is known about adherence to these recommendations. Objectives: The main objectives were to describe (i) loss to spine clinic follow-up (LTFU) and (ii) TB treatment duration among patients diagnosed with spinal TB at a major tertiary hospital in the Western Cape. Secondary objectives were to investigate (i) the association between LTFU and treatment duration and (ii) factors associated with LTFU. Methods: This retrospective cohort study included 173 adults diagnosed with spinal TB between 2012 and 2015 and investigated follow-up within 2 years from diagnosis. Clinical, demographic and appointment data were obtained from hospital records and a dataset provided by the provincial Department of Health. LTFU was presented as frequency (%) and as a survival analysis. TB treatment duration was reported as frequency (%) <9 months or ≥9 months and the association between LTFU and <9 months treatment investigated using relative risk (RR) with 95% confidence intervals (C.I.). Univariate associations between explanatory variables and LTFU were investigated using simple logistic regression. Results: Patients had a median age of 36 years (interquartile range 29-48 years) and included 98 (57%) females and 151 (87%) patients residing <50 km from the hospital. Primary outcomes were that 129 (75%) patients were LTFU within 2 years of diagnosis and 45 (30%) completed <9 months of treatment. The RR of <9 months treatment was 1.62 (95% C.I. 1.39 to 1.88) among those LTFU compared to those retained in follow-up. LTFU was not associated with any of the clinical or demographic variables investigated. Conclusion: Three quarters of patients did not complete follow-up at the tertiary hospital spine clinic and almost one in three received less than 9 months of TB treatment. Remaining in spine clinic follow-up was significantly associated with receiving at least the minimum duration of TB treatment. However, LTFU could not be predicted from routine clinical and demographic information and is likely related to factors not accounted for in the current analysis. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Agtergrond: Pasiente wat gediagnoseer word met tuberkulose (TB) van die ruggraat by 'n groot tersiere hospitaal in die Wes-Kaap, moet gereeld opvolg besoeke by die hospitaal se buitepasientruggraatkliniek bywoon en ten minste 9 maande op TB-behandeling bly. Hierdie opvolg en lang-termyn behandeling is belangrik om toe te laat vir spesialis monitering van TB behandeling reaksie, vroee identifikasie van sekondere komplikasies en verminderde risiko van herhaling. Daar is egter min bekend oor die nakoming van hierdie aanbevelings. Doelwitte: Die hoofdoelwitte was om (i) verlies aan ruggraatkliniekopvolg (LTFU) en (ii) TBbehandelingsduur te beskryf onder pasiente gediagnoseer met spinale TB by 'n groot tersiere hospitaal in die Wes-Kaap. Sekondere doelwitte was om (i) die verband tussen LTFU en behandelingsduur en (ii) faktore wat met LTFU geassosieer word, te ondersoek. Metodes: Hierdie retrospektiewe kohortstudie het 173 volwassenes tussen 2012 en 2015 gediagnoseer en ondersoek binne 2 jaar na die diagnose. Kliniese, demografiese en aanstellingsdata is verkry uit hospitaalrekords en 'n datastel wat deur die provinsiale departement van gesondheid voorsien word. LTFU is aangebied as frekwensie (%) en as oorlewingsanalise. TBbehandelingsduur is as frekwensie (%) <9 maande of ≥9 maande aangemeld en die verband tussen LTFU en <9 maande behandeling ondersoek met relatiewe risiko (RR) met 95% vertroue intervalle (C.I.). Univariate assosiasies tussen verklarende veranderlikes en LTFU is ondersoek deur eenvoudige logistieke regressie te gebruik. Resultate: Pasiente het 'n mediaan ouderdom van 36 jaar gehad (interkwartielreeks 29-48 jaar) met 98 (57%) vroue en 151 (87%) pasiente <50 km van die hospitaal. Primere uitkomste was dat 129 (75%) pasiente LTFU binne 2 jaar van diagnose en 45 (30%) het <9 maande behandeling voltooi. Die RR van <9 maande behandeling was 1,62 (95% C.I 1,39 tot 1,88) onder die LTFU in vergelyking met diegene wat in die opvolging behoue gebly het. LTFU is nie geassosieer met enige van die kliniese of demografiese veranderlikes wat ondersoek is nie. Afsluiting: 'n Driekwart van pasiente het nie hul opvolg besoeke by die tersiere hospitaal ruggraatklinik voltooi nie en byna een uit elke drie pasiente het minder as 9 maande van TB-behandeling ontvang. Om opvolg besoeke by te woon was beduidend geassosieer met die ontvangs van, ten minste, die minimum duur van TB-behandeling. LTFU kon egter nie voorspel word uit roetine- kliniese en demografiese inligting nie en is waarskynlik verwant aan faktore wat nie in die huidige analise verreken word nie. | en_ZA |
| dc.description.version | Masters | |
| dc.embargo.terms | 2022-02-20 | |
| dc.format.extent | 32 pages : illustrations, includes annexures | |
| dc.identifier.uri | http://hdl.handle.net/10019.1/105631 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | |
| dc.rights.holder | Stellenbosch University | |
| dc.subject | Spine -- Tuberculosis -- Western Cape (South Africa) | en_ZA |
| dc.subject | Tuberculosis -- Treatment | en_ZA |
| dc.subject | UCTD | |
| dc.title | Loss to follow-up among patients diagnosed with spinal tuberculosis at a tertiary hospital in the Western Cape, South Africa : a retrospective cohort study | en_ZA |
| dc.type | Thesis | en_ZA |