Treatment outcome and associated factors among adult patients with pulmonary tuberculosis in selected health centers in Addis Ababa Ethiopia

Mehiret Zerihun; Hussen Mekonnen; Tigistu Gebreyohannis Gebretensaye

doi:10.1371/journal.pone.0292218

. 2023 Oct 5;18(10):e0292218. doi: 10.1371/journal.pone.0292218

Treatment outcome and associated factors among adult patients with pulmonary tuberculosis in selected health centers in Addis Ababa Ethiopia

Mehiret Zerihun ¹, Hussen Mekonnen ¹, Tigistu Gebreyohannis Gebretensaye ^1,^*

Editor: Musa Mohammed Ali²

PMCID: PMC10553344 PMID: 37796955

Abstract

Introduction

The success rate of pulmonary tuberculosis in developing countries is different than expected despite effective treatment. We evaluated treatment outcomes and associated factors of pulmonary tuberculosis patients.

Methods

A retrospective cross-sectional study was employed among randomly selected health centers in Addis Ababa, Ethiopia. Patient records of adult pulmonary tuberculosis patients treated between January 1st, 2017, and December 31st, 2019 were reviewed. Convenient sampling technique was used to select the study participants. Statistical package for social sciences (SPSS), version 24-computer software was used for analysis. Participants’ characteristics were descriptively described, and Bivariate, and multivariate logistic regression analysis were used to determine independent variables related to clinical outcomes. The significance level was determined at p-value < 0.05 and a 95% confidence level.

Results

Six hundred thirty-six patient records with a mean age of 37.49± 2.99 were reviewed. The overall treatment success rate was 84.9%. Absence of comorbid illness [AOR = 0.444; 95% CI:0.219–0.900], non-smoking [AOR = 0.35; 95% CI:0.194–0.645], and being HIV negative [AOR = 0.22; 95% CI: 0.106–0.460] were associated with successful treatment outcomes, whereas, not having treatment supporter [AOR = 15.68; 95% CI: 8.11–30.33] was associated with unsuccessful treatment outcome.

Conclusions

Treatment success in this study was below the average target set by WHO. HIV positivity, co-morbidities, and smoking increased risk of treatment failure. Patient education about cessation may improve treatment success.

Introduction

Tuberculosis (TB) is ranked third among the top ten causes of death from infectious agents worldwide [1]. Asian and African countries share the highest burden of tuberculosis, accounting for about 68% of total cases, which is almost two thirds of the global total [2]. Ethiopia is among the world’s 22 highest TB burden countries [3].

Effective treatment and cure requires patients’ tolerance and adherence to the full course of treatment period [4]. This is because the microorganism stays inactive for some time and reactivates, making the disease relapse [5]. So being adherent and taking these long term antimicrobial by patients are the major difficulties that may increase risk of unsuccessful treatment outcomes [6]. To maximize the success rate, Ethiopia has been carrying out the directly observed treatment short course (DOTs) strategy since 1992 [7].

TB- HIV co-infection is known to form a lethal combination by speeding up disease progression [8]. Studies reported that treatment failure, death and relapse were mainly associated with HIV infection, Diabetes mellitus, low body mass index [9], and short duration of treatment [6].

According to the WHO 2017 data, the global treatment success rate has reached 85% for new TB cases, 75% for HIV associated, 56% for multi-drug resistant (MDR) and 39% for extensively drug resistant TB [2]. However, the success rate differs from country to country and with the factors that are associated with it [7].

A wide variation in treatment success rate has been seen in European countries. Slovakia and Romania had the highest rate of unsuccessful treatment outcomes, accounting for 66.7 and 55.5% respectively [2]. Unsuccessful treatment outcomes is also a challenge for Sub-Saharan countries like South Africa and Nigeria, where the prevalence of unsuccessful treatment outcomes was 20.4%, and 19.8% respectively [10, 11].

According to the annual performance report of the Federal Ministry of Health of Ethiopia (MOH) in 2017, unsuccessful treatment outcomes showed that 26% in Afar, 22% in Gambella, 18% in Somali and 10% in Addis Ababa [12]. Despite the availability of few studies reporting tuberculosis treatment outcomes among patients with all types of tuberculosis in the country, most of them were hospital based and they failed to examine the risk factors in their reports. Therefore, this study was designed to determine treatment outcomes and associated factors among patients with pulmonary TB in selected health centers in Addis Ababa Ethiopia.

Methods and materials

Study design and setting

A retrospective Cross-sectional study was conducted reviewing 694 adult pulmonary TB patient’ records who have completed their standard PTB treatment regimen (Rifampicin, Isonized, Pyrazinamide and Ethambutol) in selected health centers in Addis Ababa Ethiopia. Addis Ababa is the capital city of Ethiopia, Headquarter for African Union and United Nations Economic Commission for Africa. It has a subtropical highland climate with an average elevation of 2355 m above sea level with a total surface area of 527 Km². subdivided into ten sub cities [13]. The health centers in the city provide preventive as well as curative services to the community under the administration of Addis Ababa health bureau [14].

Population

Medical records of all pulmonary TB patients treated with standard anti TB drug regimen at the selected health centers in Addis Ababa from January 1^st 2017- December 31^st 2019 were included.

Eligibility

All medical records of pulmonary tuberculosis patients aged 18 years and above registered as new, pretreatment and transfer in patients were included. Medical records of pulmonary tuberculosis patients with incomplete data and patients who were transferred to other health facilities were excluded.

Sampling technique and procedure

Sample size was calculated using single population proportion formula

n = Z^{2} \times \frac{p (1 - p)}{d^{2}} DEFF

Where;

n = the required sample size

P = 50% = 0.5 since there is no similar research conducted in Ethiopia

Z = 1.96 (i.e., for a 95% CI)

d = 0.05

DEFF = design effect

384 * 1.5 + 10 % = 633

Since the total adult patients treated for pulmonary tuberculosis in the selected health centers were 694, the investigators decided to enroll all charts of pulmonary tuberculosis patients treated in the selected health centers.

Among the ten Sub-cities in Addis Ababa, four sub-cities which include, Nifas silk, Lideta, Gullele and Yeka were selected using simple random sampling method. There were twenty health centers within the four Sub-cities, and (six), health centers were in the same manner the Sub-cities selected. Finally, medical records of all adult pulmonary Tb patients were conveniently included and reviewed.

Data collection, management and analysis

Structured checklists adopted from previous studies on similar topics were used to extract data [5, 8]. The instrument was pretested in a health center other than the randomly selected health centers. The checklist consisted two sections: (Socio-demographic characteristics and clinical characteristics). Treatment outcomes were categorized as treatment success, when a patient ends up in cure or treatment completion, and unsuccessful treatment outcome, when a patient ends up in treatment failure, death or default. Experienced data collectors were recruited and trained. The principal investigators on a daily basis supervised the data collection process. Data was checked for completeness, coded and entered into Epi-data version 3.5.1 and exported into SPSS version 24 statistical packages for social sciences for analysis. Descriptive statistics were used to describe participant’s characteristics, and logistic regression: (Bivariate and Multivariable) analysis was used to determine association between independent and outcome variables. Variables with a p-value less than 0.2 in Bivariate analysis were included into the multivariable logistic regression model for analysis and a p-value < 0.05 at a 95% confidence interval was considered significant.

Ethical approval

Ethical approval Ref: AAUMF/02-008/NUR2020 was obtained from the Institutional review board of Collage of Health Science in Addis Ababa University. The need for informed consent was waived by the Institutional Review Committee of the College of Health Sciences, Addis Ababa University, for the fact that, the nature of the study was retrospective. Data was collected by recruiting experienced staff nurses working in the settings, and participants’ information was kept private in a safe and secured place to ensure confidentiality.

Results

Patient characteristics and treatment outcome of pulmonary TB patients

Among the total of 694 patient charts reviewed, 636 (91.6%) patient records were found to have complete data. The mean age of participants was 37.49± 12.99 with a minimum age of participants 18 years and a maximum of 86 years old. Of these, 361 (56.8%) were male. More than two-thirds, 453 (71.2%) weighed between 55 and 70.9 Kg. The majority, 553 (86.9%) of the participants were Addis Ababa, city residents. More than three quarters, 481 (75.6%) of PTB patients in this study were new cases, 384 (60.4%) of them were smear positive, and 106 (16.7%) were found HIV positive. More than a quarter of the patients, 173 (27.2%) were cigarette smokers. Concerning patients’ outcomes, the study found that 540 (84.9%) demonstrated successful pulmonary TB treatment outcomes. Of these, 207 (38.3%) were cured and 333 (61.7%) completed treatment. On the other hand, the prevalence of unsuccessful treatment outcomes was 97 (15.2%), of which 18 (2.8%) died during the course of treatment, 33 (5.2%) were treatment failures and 46 (7.2%) were defaulters. Out of the total patients who had unsuccessful treatment outcomes, 34% of them were HIV positive, 16.7% were smear positive, and 23% were cigarette smokers. The patient charts review also revealed that, 122 (19.2%) PTB patients were reported to have other co-morbid illnesses, of which 27.9% of them were among the patients who were reported to have unsuccessful treatment outcomes. A total of 87 (13.8%) PTB patient were found to have no treatment supporter, and unsuccessful treatment outcomes were reported among (39.1%) of them (Table 1).

Table 1. Patient characteristics and treatment outcome of PTB patients at selected health centers in Addis Ababa, Ethiopia, between January 1, 2017 and December 31, 2019.

(n = 636).

Characters		Treatment outcomes
	Category	Successful		Unsuccessful			Total F (%)
	Category	Cured F (%)	Treatment completed F (%)	Died F (%)	Failed F (%)	Defaulter F (%)	Total F (%)
Age in years	18–24	32(5.0)	42(6.6)	2(0.3)	7(0.6)	8(1.25)	91(14.3)
	25–34	73(11.5)	105(16.5)	4(0.6)	5(0.6)	12(1.9)	199(31.3)
	35–44	63(9.9)	90(14.1)	1(0.2)	9(1.4)	15(2.4)	178(28)
	45–54	30(4.7)	63(9.9)	2(0.3)	4(0.5)	7(1.1)	106(16.7)
	≥55	9(1.4)	33(5.2)	9(1.4)	8(1.3)	4(0.6)	62(9.7)
Sex	Male	105(16.5)	202(31.8)	13(2.0)	7(1.1)	34(5.3)	361(56.8)
Sex	Female	106(16.7)	137(21.5)	6(0.9)	14(2.2)	12(1.9)	275(43.2)
Residence	Addis Ababa	194(30.5)	290(45.6)	13(2.0)	17(2.7)	39(6.1)	553(86.9)
Residence	Other cities	17(2.7)	49(7.7)	5(0.8)	4(0.6)	8(1.3)	83(13.1)
Weight	30–39.9	0	3(0.5)	1(0.2)	0	2(0.3)	6(0.9)
	40–54.9	62(9.7)	60(9.4)	1(0.2)	8(1.3)	11(1.7)	142(22.3)
	55–70.9	144(22.6)	256(40.3)	14(2.2)	12(1.9)	27(4.2)	453(71.2)
	≥71	5(0.8)	20(3.1)	2(0.3)	1(0.2)	7(1.1)	35(5.5)
Patient category	New	183(28.9)	255(40.1)	9(1.4)	8(1.25)	26(4.1)	481(75.6)
	Relapse	6(0.9)	23(3.6)	3(0.5)	2(0.3)	5(0.8)	39(6.1)
	Treatment failure	0	9(1.4)	3(0.5)	3(0.4)	9(1.4)	24(3.8)
	Treatment defaulter	4(0.6)	15(2.3)	2(0.3)	9(1.4)	2(0.3)	32(4.9)
	Transferred in	18(2.8)	37(5.8)	1(0.2)	0	4(0.6)	60(9.4)
Other Co morbidities	Yes	27(4.2)	61(10)	7(1.1)	12(1.9)	15(2.3)	122(19.2)
Other Co morbidities	No	184(29)	278(44)	11(1.7)	10(1.5)	31(4.8)	514(80.8)
HIV/AIDS status	Positive	20(3.1)	50(7.9)	11(1.7)	9(1.4)	16(2.5)	106(16.7)
HIV/AIDS status	Negative	191(30.0)	289(45.4)	9(1.4)	12(1.9)	29(4.6)	530(83.3)
Smear result status	Positive	111(17.5)	98(15.4)	6(0.9)	12(1.9)	24(3.7)	251(39.5)
Smear result status	Negative	100(15.7)	241(37.8)	12(1.9)	9(1.4)	24(3.8)	384(60.4)
Smoking history	Yes	46(7.2)	88(13.8)	8(1.3)	3(0.5)	29(4.6)	174(27.2)
Smoking history	No	165(26)	251(39.4)	10(1.5)	19(3.0)	17(2.6)	462(72.7)
Treatment supporter	Yes	198(31.1)	309(49)	14(2.2)	8(1.5)	19(2.9)	549(86.3)
Treatment supporter	No	13(2.0)	30(4.7)	4(0.6)	13(2.0)	27(4.2)	87(13.8)

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HIV: Human Immunodeficiency Virus, AIDS: Acquired Immunodeficiency Syndrome

Treatment outcome among pulmonary tuberculosis patients in selected health centers

The overall success rate of pulmonary tuberculosis patients treated with a standard anti-tuberculosis treatment regimen was found to be (84.8%).

Treatment success showed incensement with time from (79.4%) in the year 2017 to (92.2%) in the year 2019, and a reduction in mortality rate from 20.4% to 2.04% during the study period. A total of 633 PTB patients’ records were reviewed. Patients who end up either in cure or treatment completion were regarded as having successful treatment outcomes, while those who reported treatment failure, death, or default were considered as unsuccessful treatment outcomes (Fig 1).

Data from the study area shows that, considerable proportions (15.2%), of pulmonary tuberculosis patients who took standard anti-tuberculosis treatment regimen have unsuccessful treatment outcome.

Factors associated with treatment outcome among PTB patients

In the logistic regression model, variables with p-value <0.2 in Bivariate regression model were deemed for the multivariate regression models and treatment after failure, treatment after default, other co morbidities, HIV/AIDS serologic status, History of smoking and presence of treatment supporter were found to be the factors significantly associated with TB treatment outcome. TB patients taking treatment after failure were more than 9 times more likely to have unsuccessful treatment outcome compared to new cases and those TB patients taking treatment after default were more than 9 times more likely to have unsuccessful treatment outcome compared to new cases (AOR = 9.105, 95% CI 3.120–26.572) and (AOR = 9.075, 95% CI 3.630–22.685) respectively. Those TB patients who had no other co-morbid condition were 0.44 times less likely to have unsuccessful treatment outcomes as compared to those who have co-morbid conditions (AOR = 0.444 95% CI 0.219–0.90). Similarly, those TB patients with HIV negative serologic status were 0.22 times less likely to have unsuccessful treatment outcome than HIV positives pulmonary TB patients (AOR = 0.221 95% CI 0.106–0.460). History of smoking was also another determinant factor associated with pulmonary TB treatment outcome. Those patients who had no history of smoking were 0.35 times less likely to have unsuccessful treatment outcomes as compared to those who had history of smoking (AOR = 0.354 95% CI 0.194–0.645). However, lack of treatment supporter was negatively associated with unsuccessful treatment outcome. Those TB patients who were reported to have no treatment supporter were more than 15 times more likely to have unsuccessful treatment outcome than those who reported to have treatment supporter(AOR = 15.684 95% CI 8.111–30.330). (Table 2)

Table 2. Factors associated with treatment outcome among TB patients in selected health centers in Addis Ababa, Ethiopia between 1st January 2017 and 31st December 2019.

(n = 636).

Variable	Category	Treatment outcomes		AOR	P-value
Variable	Category	Successful	Unsuccessful	AOR	P-value
Patient category	New	438(69)	43(6.75)	1
	Relapse	29.0(4.5)	11(1.8)	1.804(0.677, 4.811)	0.238
	Treatment after failure	9(1.4)	14(2.2)	9.105(3.120, 26.572)	<0.0001^**
	Treatment after default	19(2.9)	13(2.0)	9.075(3.630, 22.685)	<0.0001^**
	Transferred in	55(8.6)	5(0.8)	0.999(0.339, 2.946)	0.999
Other Co morbidities	Yes	88(14.2)	34(5.3)	1
Other Co morbidities	No	462(73)	52(8.0)	0.444(0.219, 900)	0.024^**
HIV/AIDS status	Positive	71(11.2)	35(5.5)	1
HIV/AIDS status	Negative	480(75.4)	50(7.9)	0.221(0.106, 0.460)	0.0001^**
History of smoking	Yes	135(21.2)	39(6.2)	1
History of smoking	No	416(65.4)	46(7.1)	0.354(0.194, 0.645)	<0.001^**
Treatment supporter	Yes	507(80.1)	42(7.6)	1
Treatment supporter	No	43(6.7)	44(6.8)	15.684(8.111, 30.33)	<0.0001^**

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* = P-value < 0.05,

** = P-value < 0.01,

AOR (Adjusted odds ratio), 1(reference category), HIV: Human Immunodeficiency Virus, AIDS: Acquired Immunodeficiency Syndrome

Discussion

In this study, unsuccessful treatment outcomes among PTB patients were 15.2%, which is higher than the target set by WHO for the year 2020 [2]. The finding was higher than the studies conducted in Jimma and Harar [15, 16], but lower than Gondar, Hosanna, Gambella, and Sodo towns [7, 17–19]. Another study in the Afar region, in Eastern Ethiopia, also reported 18.2%, which is slightly higher than the current study [20]. The success rate has improved between the years from (79.5%) in the year 2017 to (92.2%) in the year 2019 which may be due to improved implementation of the DOTs strategy and improved efforts made to increase patient awareness. The overall mortality rate decreased from 20.4% to 2.04% during the study period, which is consistent with the study done in Denmark [21]. The increase in public health awareness and increased quality of TB control programs may have contributed to the improved outcomes. The current study found that patient re-treatment after failure and/or after defaulters is associated with unsuccessful pulmonary TB treatment outcome. Those treated after failure and/or after default were 9 times more likely to have an unsuccessful treatment outcome than in new cases of pulmonary TB patients. This was similar with findings in Uzbekistan, where a higher proportion of patients encountered unsuccessful treatment outcomes among re-treatment cases [22]. Similarly, other studies [6, 23] also supported the finding by stating that patients who have previously defaulted on their treatment were more likely to fail their treatment compared to their counterparts.

Negative HIV serological test among pulmonary TB patients was another factor significantly associated with positive TB treatment outcome. Pulmonary TB patients with a negative HIV serological test were 0.22 times less likely to have unsuccessful treatment outcome than those pulmonary TB patients who were HIV positive. The finding was similar to the findings of five year retrospective study conducted in the University of Gondar teaching hospital and south-eastern Nigeria [17, 23]. The finding was also supported by another study conducted in Afar regional state in Eastern Ethiopia [20]. The later study also reported that re-treatment of cases has a high chance of having unsuccessful treatment outcomes as compared to new cases like the current study. The finding was also similar to studies at Haramaya University in Eastern Ethiopia and other similar studies [6, 17, 22, 24]. Co-morbid illness among pulmonary TB patients was significantly associated with TB treatment outcomes. In this study, other co-morbid illnesses and smoking were significantly associated with TB treatment outcomes. Pulmonary TB patients who were not smokers were 0.35 times less likely to have unsuccessful treatment outcome than smoking patients, which is consistent with other study findings [25]. Finally, having treatment supporter was found to be significantly associated with unsuccessful TB treatment outcomes. Patients who do not have treatment supporters were more than 15 times more likely to have unsuccessful treatment outcomes compared to those who were reported to have treatment supporters. The finding is similar to the countrywide study in Ethiopia, which reported statistical significance that supporter and degree of drug resistance were linked to TB treatment outcomes [26].

Study limitations

This facility-based study used in this study was cross-sectional study design, which may hinder to show cause and effect relation-ship. Not all risk factors for TB treatment success were exhausted, due to incomplete recording in the patient records. The study may have suffered with misclassification bias. The study may be vulnerable for information and selection bias, since diagnostic criteria in health centers may not be based on uniform criteria, making it at risk for information bias, and all cases who don’t attend those clinics or seek care during the study period may be missed. Further, it used secondary data in which all conditions together may affect generalizability of the study to a broader community, resulting in drawbacks to draw conclusions beyond the study settings.

Conclusion and recommendation

Unsuccessful treatment outcomes among PTB patients in this study is 15.1%, higher than the global target set by WHO, lower than 10%. Being HIV negative, not having other co-morbid illness, re-treatment cases (Treatment after failure and Treatment after default), history of smoking were positively associated with treatment success, while, not having treatment supporter was negatively significantly associated with successful TB treatment outcomes among pulmonary TB patients. Patient education, encouragement of drug adherence establishment of home visits and advocating DOTS strategy may be necessary to improve unsuccessful TB treatment outcomes.

Acknowledgments

First, we would like to acknowledge Addis Ababa University, college of health science school of nursing and midwifery for giving me this chance to do this thesis. I would also like to thank college of health science library.

Abbreviations

AAU: Addis Ababa University
AOR: Adjusted odds’ ratio
BMI: Body mass index
CI: Confidence Interval
DM: Diabetes Mellitus
DOTs: Direct observation therapy short course
HCs: Health centers
HIV: Human immune deficiency virus
Kg: Kilograms
NTLCP: National Tuberculosis and Leprosy Control Program
OR: Odd Ratio
PTB: Pulmonary Tuberculosis
SPSS: Statistical Package for Social Sciences
TB: Tuberculosis
WHO: World Health Organization

Data Availability

The data underlying the results presented in the study are available from the Addis Ababa University repository at http://etd.aau.edu.et/handle/123456789/24133 and/or the corresponding author on reasonable request.

Funding Statement

The authors received no specific funding for this work.

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PLoS One. doi: 10.1371/journal.pone.0292218.r001

Decision Letter 0

Musa Mohammed Ali

17 Apr 2023

PONE-D-23-04424Treatment Outcome and Associated factors among Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa EthiopiaPLOS ONE

Dear Dr. GEBRETENSAYE,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Musa Mohammed Ali, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments:

After careful assessment, your manuscript has merit; however, it does not fully meet PLOS ONE’s publication criteria. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

1. Give number ‘1’for all authors as they all have the same affiliation. And also correct authors affiliation accordingly “1School of Nursing and Midwifery College of Health Science, Addis Ababa University Addis Ababa, Ethiopia”

2. Is this study retrospective cross-sectional study or retrospective cohort study?

3. Define or describe ‘standard anti TB drug regimen’

4. ‘Sampling technique and procedure’ need revision: how many sub-cities are there in Addis Ababa? “…six health centers were selected based on proportional allocation from each sub city according to the number of health centers in each…” need further elaboration.

5. Ethical approval: “Ethical approval Ref: AAUMF/02-008/NUR2020 was obtained from Research Ethics Committee of Addis Ababa University Collage of Health Science School of Nursing and Midwifery.” Is “……School of Nursing and Midwifery….” Legally registered institution to provide ethical approval?

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I belive that this study will be interesting, but following issues must be solved.

1. The English language used in the submission must be edited.

2. Flow of the article must be corrected.

3. Material and methods section of abstract is over long. No need for such details.

4. The introduction section is also very long. Please shorten this section according to the main objective of your study.

5. You didn’t include the patients below 18 years. Why? If it is possible, please add the pediatric patient, too. If not, the title deserves a revision accordingly. (For example, …among adult Patients with Pulmonary…)

6. You studied a limited number of potential risk factors in your study. Studies reported that diabetes mellitus, drug resistant bacilli, high bacilli load in sputum smear, cavitary lesion in the lungs are the risk factors for unfavorable clinical outcomes of tuberculosis treatment. If it is possible, please consider adding such factors in the study. If not, please discuss them as a limitation.

7. Please extend your discussion with the results of similar studies, weight your findings, and make your suggestions to limit treatment failures.

Reviewer #2: This article talk about the research of the factors associated with the therapeutic success in the tuberculosis treatment in Addis Abeba and around.

In the introduction according to the annual FDRE MOH the success rate in Addis Abeba was 90% in accordance with international requirements but not well understood the inconsistencies because in the same country the reasons can be different by city because different environment.

It would be better to explain the inconsistencies that require this study.

If the term therapeutic success is the desired goal, there must be consistency in the writing to facilitate reading

It will also be necessary to harmonize the font

For the sampling I did not understand the technique of the proportional allocation. This proportionality is a function of the number of patients followed or the geolocalization

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Yusuf Yakupogullari

Reviewer #2: No

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Attachment

Submitted filename: Review assignment for PONE-D-23-04424.docx

Click here for additional data file.^{(12.2KB, docx)}

PLoS One. 2023 Oct 5;18(10):e0292218. doi: 10.1371/journal.pone.0292218.r002

Author response to Decision Letter 0

9 Jun 2023

Dear Chief-editor and Reviewers,

Thank you for taking your precious time to review our manuscript: ID PONE-D-23-04424 “Treatment Outcome and associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa Ethiopia”.

We have received the reviewer comments from Elsevier’s Author Hub. All comments focused on the instrument section and we have addressed the comments as follows:

Reviewer's comments and their response

Comments: Ensure that your PLOS ONE's style requirements

Response Manuscript edited to meet PLOS ONE's style requirements

Comment::Include the relevant URLs, DOIs, or accession numbers within your revised cover letter

Access URLs included in the data availability section and the revised cover letter

Comment: Include a separate caption for the figure in your manuscript

Response: The figure caption is included as recommended

Comment: Give number 1 for all authors as they all have the same affiliation

Response: Changes made as suggested by the editors

Comment: Is this study a retrospective cross-sectional study or a retrospective cohort study?

Response: The study design is a retrospective cohort study since the analysis involves the comparison of groups

Comment: Define or describe a ‘standard anti-TB drug regimen’

Response: Standard anti-TB drug regimen used by studied patients stated as suggested

Comment: Sampling technique and procedure’ need revision: how many sub-cities are there in Addis Ababa?

Response: Revised and missing components added as per the suggestion

Comment: State the correct office that is responsible issue ethical approval in the institution.

Response: Ethical approval is issued at the College level and the section is revised as the College of Health Sciences.

Comment: The English language used in the submission must be edited.

Response: The English language was edited in consultation with language experts.

Comment: The flow of the article must be corrected.

Response: The article flow was corrected as per the suggestion.

Comment: The material and methods section abstract is over long

Response: We decided to keep this section since there are no word count recommendations for the journal, and we believed the components are important.

Comment: The introduction section is also very long. Please shorten this section according to the main objective of your study.

Response: Revised as suggested.

Comment: You didn’t include patients below 18 years.

Response: Changes have been made to the title since all participants were adult patients.

Comment: You studied a limited number of potential risk factors in your study.

Response: We were limited to fewer numbers risk factors fact some of the variables were not recorded in the patient records. Therefore, we have included a statement in the study limitation section.

Comment: Please extend your discussion with the results of similar studies.

Response: Efforts were made to make changes in the section

Attachment

Submitted filename: Response to Reviewers.docx

Click here for additional data file.^{(20.8KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0292218.r003

Decision Letter 1

Musa Mohammed Ali

18 Jul 2023

PONE-D-23-04424R1Treatment Outcome and Associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa EthiopiaPLOS ONE

Dear Dr. GEBRETENSAYE,

==============================Academic editor’s comment • Include the sub-heading ‘Introduction’ in the abstract • In the manuscript, both retrospective cross-sectional and cohort study designs are mentioned. The appropriate study design needs to be used consistently thorough out the manuscript. • Paraphrase descriptions in abstract line #35 “Convenient sampling techniques were employed to review patient…” convenient sampling technique is to be used to select study participants • Omit “Background” from line #53• Line #75 “….outcomes was 20.4, and 19.8 respectively” Are these values in % or frequency? • Line # 123 in a statement “was obtained from Research Ethics Committee of Addis Ababa University..” nomenclature ‘Research Ethics Committee needs to be checked out unless it is changed; the correct name is ‘Institutional Review Board’ check and amends wherever it applies. • Consider including sample size determination and how proportional allocation was performed? • Include all abbreviations used in the tables as footnotes in their expanded form• Table 1. Are age categories in years? Include unit for weight • I suggest using ‘multivariable analysis’ instead of ‘multivariate analysis

==============================

Please submit your revised manuscript by Sep 01 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Musa Mohammed Ali, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear Dr. Tigistu.

Thank you for sending your manuscript to PLOS ONE. I have received reviewers’ comments on the revised manuscript; still, there are some points to be addressed before accepting the manuscript for publication. Would you respond to additional comments given by the reviewers’?

Academic editor’s comment

In addition address the following points

• Include the sub-heading ‘Introduction’ in the abstract

• In the manuscript, both retrospective cross-sectional and cohort study designs are mentioned. The appropriate study design needs to be used consistently thorough out the manuscript.

• Paraphrase descriptions in abstract line #35 “Convenient sampling techniques were employed to review patient…” convenient sampling technique is to be used to select study participants

• Omit “Background” from line #53

• Line #75 “….outcomes was 20.4, and 19.8 respectively” Are these values in % or frequency?

• Line # 123 in a statement “was obtained from Research Ethics Committee of Addis Ababa University..” nomenclature ‘Research Ethics Committee needs to be checked out unless it is changed; the correct name is ‘Institutional Review Board’ check and amends wherever it applies.

• Consider including sample size determination and how proportional allocation was performed?

• Include all abbreviations used in the tables as footnotes in their expanded form

• Table 1. Are age categories in years? Include unit for weight

• I suggest using ‘multivariable analysis’ instead of ‘multivariate analysis

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: (No Response)

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #1: 1- In the abstract (methods subsection), please shorthen the details of statistical analyses.

2- In the abstract (in results subsection), please use a correct expression for the following sentence: "Comorbid illness

[AOR=0.444; 95% CI:0.219-0.900], smoking [AOR= 0.35; 95% CI:0.194-0.645], being HIV negative [AOR=0.22; 95% CI: 0.106- 0.460], and treatment support [AOR=15.68; 95% CI: 8.11-30.33] were associated with tuberculosis treatment outcome." for better outcome or worst outcome?

3- In the abstract (in results subsection), you stated that the succes rate for your patients was 84.9%; and in Conclusion subsection, you stated that the succes rate found this study was below the WHO's suggestion. You should have evaluated this result according to the patients' risk factors. for example, what was the succes rate among the patients without any risk factor, and what was the succes rate among the patients with one or more risk factor?

I have no further suggestion for the other parts of the manuscript. Good luck for your next studies!

Reviewer #2: I didn't quite understand the term proportionality in this sentence.

« .Within the four Sub-cities, there were twenty health

105 centers and one third (six), health centers were selected proportionally from each sub city

106 according to the number of health centers in each. »

proportional to what?

One of your selection criteria was to receive a selection of centers with a number of people to consult greater than .........

« A structured checklist adopted from previous studies on a similar topic was used to extract data

111 (8) »

The information on the checklist is insuffisant. checklist is validated ? have you done a pretest?

The Authors say that it has been used in several studies but there is only one reference. this checklist should be part of your limits because the measuring tool is not necessarily the same as the studies you are comparing the results of your study.

About the limits of the study

The question is: can this study be generalized to the whole country?

The Authors must add the criteria of information bias with the checklist and perhaps selection bias, as those who were very ill may not have been able to visit the centers.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Yusuf YAKUPOGULLARI

Reviewer #2: Yes: MAMA DJIMA Mariam

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Attachment

Submitted filename: Review assignment V2VD for PONE-D-23-04424.docx

Click here for additional data file.^{(12.5KB, docx)}

PLoS One. 2023 Oct 5;18(10):e0292218. doi: 10.1371/journal.pone.0292218.r004

Author response to Decision Letter 1

26 Jul 2023

Dear Chief-editor and Reviewers,

Thank you for taking your precious time reviewing our manuscript: ID PONE-D-23-04424 “Treatment Outcome and associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa Ethiopia”.

We have received the reviewer comments from Elsevier’s Author Hub. All comments focused on the instrument section and we have addressed the comments as follows:

Response to review comments:

Additional Information:

S/No Comment Response

1 Include the sub-heading ‘Introduction’ in the abstract

Sub-heading ‘Introduction’ included in the abstract section

2 In the manuscript, both retrospective cross-sectional and cohort study designs are mentioned. The appropriate study design needs to be used consistently thorough out the manuscript.

The study design is revised as retrospective cross-sectional study design thorough out the document as recommended.

3 • Paraphrase descriptions in abstract line #35 “Convenient sampling techniques were employed to review patient…” convenient sampling technique is to be used to select study participants

The statement convenient sampling techniques were employed to review patient charts, paraphrased as suggested in the comment

4 Omit “Background” from line #53

Sub-heading “Background” omitted from the introduction section.

5 Line #75 “….outcomes was 20.4, and 19.8 respectively” Are these values in % or frequency? T

he outcome values 20.4, and 19.8 are percent and indicated in the mentioned values.

6 Line # 123 in a statement “was obtained from Research Ethics Committee of Addis Ababa University..” nomenclature ‘Research Ethics Committee needs to be checked out unless it is changed; the correct name is ‘Institutional Review Board’ check and amends wherever it applies

Nomenclature of the Ethics approval body is revised as “Institutional review board of Collage of Health Science in Addis Ababa University”.

7 Consider including sample size determination and how proportional allocation was performed?

Sample size calculation included as indicated in the appropriate section

8 Include all abbreviations used in the tables as footnotes in their expanded form

Abbreviations used within tables are indicated as footnotes in their expanded form as recommended

9 Table 1. Are age categories in years? Include unit for weight

Unit of measurement for age included as “age in years”.

10 I suggest using ‘multivariable analysis’ instead of ‘multivariate analysis

Multivariate analysis method is replaced as “multivariable” as recommended by the editor.

Reviewer

1 I didn't quite understand the term proportionality in this sentence.

« .Within the four Sub-cities, there were twenty health

105 centers and one third (six), health centers were selected proportionally from each sub city

106 according to the number of health centers in each. »

proportional to what?

One of your selection criteria was to receive a selection of centers with a number of people to consult greater than ......... This statement is revised as “Among the ten Sub-cities in Addis Ababa, four sub-cities which include, Nifas silk, Lideta, Gullele and Yeka were selected using simple random sampling method. There were twenty health centers within the four Sub-cities, and (six), health centers were in the same manner the Sub-cities selected”.

2. A structured checklist adopted from previous studies on a similar topic was used to extract data (8).

The information on the checklist is insufficient. Checklist is validated ? have you done a pretest?

We have used data from the existing cited sources (5, 8). we assumed these articles to be validated earlier, however the checklist was pretested in a setting other that the selected study settings.

3. The Authors say that it has been used in several studies but there is only one reference. This checklist should be part of your limits because the measuring tool is not necessarily the same as the studies you are comparing the results of your study.

This is revised and included more citation.

4 Can this study be generalized to the whole country? The response for this question is already reflected in the limitation section, stating “ the findings may not be generalized beyond the study settings.

. 5 The Authors must add the criteria of information bias with the checklist and perhaps selection bias, as those who were very ill may not have been able to visit the centers

This is also included in the limitation of the study.

Attachment

Submitted filename: Response to review comments PTB treatment outcome.docx

Click here for additional data file.^{(20.3KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0292218.r005

Decision Letter 2

Musa Mohammed Ali

1 Aug 2023

PONE-D-23-04424R2Treatment Outcome and Associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa EthiopiaPLOS ONE

Dear Dr. GEBRETENSAYE,

Please submit your revised manuscript by Sep 15 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Musa Mohammed Ali, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments:

Dear Dr. Tisgistu,

I have noticed that some of what have been mentioned in point by point response is not reflected in the revised manuscript such as issue of generalization, information and selection bias. All of these are not included in the limitation. Would you revise the manuscript accordingly?

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PLoS One. 2023 Oct 5;18(10):e0292218. doi: 10.1371/journal.pone.0292218.r006

Author response to Decision Letter 2

2 Aug 2023

Dear Chief-editor and Reviewers,

We have received the reviewer comments from Elsevier’s Author Hub. All comments focused on the instrument section and we have addressed the comments as follows:

Response to review comments:

Upload a copy of Figure 1 which you refer to in your text on page 9

Response; Figure 1 uploaded as separate file

Attachment

Submitted filename: Response to the editor.docx

Click here for additional data file.^{(15KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0292218.r007

Decision Letter 3

Musa Mohammed Ali

17 Aug 2023

PONE-D-23-04424R3Treatment Outcome and Associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa EthiopiaPLOS ONE

Dear Dr. GEBRETENSAYE,

==============================

ACADEMIC EDITOR:Dear Dr Tigistu,Some comments given by reviewer 1 were not still addressed. Would you carefully see the comments and revise the manuscript accordingly. I strongly suggest to consider writing style suggested by reviewer 1.

==============================

Please submit your revised manuscript by Oct 01 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

We look forward to receiving your revised manuscript.

Kind regards,

Musa Mohammed Ali, PhD

Academic Editor

PLOS ONE

Journal Requirements:

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #1: In the abstract there are still unnecessary details related to statistical analyses. please mention only which statistical analyses were used to assess for which aim. For example, "multivariate logistic regression analyses was used to determine independent variables related to clinical outcomes".

In the abstract, you mentioned the associated factors in the result section but you didn't mention how an associated factor was related to which outcome. For example, HIV negativity was related to treatment succes (or failure)".

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Yusuf YAKUPOGULLARI

Reviewer #2: Yes: MARIAM MAMA DJIMA

**********

PLoS One. 2023 Oct 5;18(10):e0292218. doi: 10.1371/journal.pone.0292218.r008

Author response to Decision Letter 3

25 Aug 2023

Dear Chief-editor and Reviewers,

Thank you for taking your precious time reviewing our manuscript: ID PONE-D-23-04424R3 “Treatment Outcome and associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa Ethiopia”.

We have received the reviewer comments from Elsevier’s Author Hub. All comments focused on the instrument section and we have addressed the comments as follows:

Response to review comments:

Comment: In the abstract there are still unnecessary details related to statistical analyses. Please mention only which statistical analyses were used to assess for which aim.

Response: Statistical analysis methods used are corrected and stated based on the recommendation given.

Comment: In the abstract, associated factors mentioned in the result section didn't indicate how an associated factor was related to which outcome.

Response: Correction made to the result section, to indicate which variable is associated to successful, and which ones are linked to unsuccessful treatment outcomes.

Comment: suggestions on the writing style

Response: Some statements are revised to make sure readers easily understand the paper. Irrelevant statements removed.

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PLoS One. doi: 10.1371/journal.pone.0292218.r009

Decision Letter 4

Musa Mohammed Ali

18 Sep 2023

Treatment Outcome and Associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa Ethiopia

PONE-D-23-04424R4

Dear Dr. Tigistu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Musa Mohammed Ali, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Reviewer #1: Revision suggestions were performed adequately. I think there are some minor polish requirement during the editing.

Reviewer #2: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: Yes: Yusuf YAKUPOGULLARI

Reviewer #2: Yes: MAMA DJIMA MARIAM

**********

PLoS One. doi: 10.1371/journal.pone.0292218.r010

Acceptance letter

Musa Mohammed Ali

26 Sep 2023

PONE-D-23-04424R4

Treatment Outcome and Associated factors among Adult Patients with Pulmonary Tuberculosis in Selected Health Centers in Addis Ababa Ethiopia

Dear Dr. Gebretensaye:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Musa Mohammed Ali

Academic Editor

PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

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Data Availability Statement

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Treatment outcome and associated factors among adult patients with pulmonary tuberculosis in selected health centers in Addis Ababa Ethiopia

Mehiret Zerihun

Hussen Mekonnen

Tigistu Gebreyohannis Gebretensaye

Roles

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Methods and materials

Study design and setting

Population

Eligibility

Sampling technique and procedure

Data collection, management and analysis

Ethical approval

Results

Patient characteristics and treatment outcome of pulmonary TB patients

Table 1. Patient characteristics and treatment outcome of PTB patients at selected health centers in Addis Ababa, Ethiopia, between January 1, 2017 and December 31, 2019.

Treatment outcome among pulmonary tuberculosis patients in selected health centers

Fig 1. Treatment outcome among pulmonary tuberculosis patients in selected health centers in Addis Ababa Ethiopia.

Factors associated with treatment outcome among PTB patients

Table 2. Factors associated with treatment outcome among TB patients in selected health centers in Addis Ababa, Ethiopia between 1st January 2017 and 31st December 2019.

Discussion

Study limitations

Conclusion and recommendation

Acknowledgments

Abbreviations

Data Availability

Funding Statement

References

Decision Letter 0

Musa Mohammed Ali

Roles

Author response to Decision Letter 0

Decision Letter 1

Musa Mohammed Ali

Roles

Author response to Decision Letter 1

Decision Letter 2

Musa Mohammed Ali

Roles

Author response to Decision Letter 2

Decision Letter 3

Musa Mohammed Ali

Roles

Author response to Decision Letter 3

Decision Letter 4

Musa Mohammed Ali

Roles

Acceptance letter

Musa Mohammed Ali

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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