Undernutrition and Treatment Success in Drug-Resistant Tuberculosis in Uganda

Undernutrition is associated with unfavourable treatment outcomes among people with drug-resistant tuberculosis (DRTB). Factors influencing the treatment outcomes among undernourished people with DRTB are not well characterised. The aim of this study was to determine factors associated with treatment success among undernourished people with DRTB in Uganda.

We analysed data from a retrospective cohort of people with DRTB from 16 treatment sites in Uganda. We included participants with a pre-treatment body mass index (BMI) of <18.5 kilograms/meters² (kg/m²). Participants were categorised as having mild (BMI of 18.5-17 kg/m²), moderate (BMI of 16.9-16.0 kg/m²) or severe (BMI of <16.0 kg/m²) undernutrition. We performed logistic regression analysis to determine factors associated with treatment success.

Among 473 people with DRTB, 276 (58.4%) were undernourished (BMI < 18.5 Kg/m²) and were included in the study. Of these, 92 (33.3%) had mild, 69 (25.0%) had moderate and 115 (41.7%) had severe undernutrition. The overall treatment success rate (TSR) for the undernourished was 71.4% (n = 197). Although the TSR was similar among participants with mild (71.7%), moderate (78.3%) and severe (67.0%) undernutrition (p = 0.258), all treatment failure cases (n =6) were among participants with severe undernutrition (p = 0.010). Cigarette smoking (odds ratio (OR) = 0.19, 95% CI 0.07-0.47, p < 0.001), urban residence (OR = 0.31, 95% CI 0.14-0.70, p = 0.005) and moderate (OR = 0.14, 95% CI 0.06-0.35, p < 0.001) and severe anaemia (OR = 0.06, 95% CI 0.01-0.29, p = 0.001) were associated with lower odds of treatment success.

Most undernourished people with DRTB have severe undernutrition. Smoking and anaemia are modifiable factors which upon appropriate intervention could improve treatment success. The effect of urban residence on the TSR needs to be evaluated further.