Factors associated with unsuccessful treatment outcome among new pulmonary tuberculosis patients in Malaysia: a retrospective cohort study

Introduction: Achieving the World Health Organization's (WHO) target treatment success rate for new tuberculosis (TB) cases remains a challenge despite the TB End strategy and ongoing control efforts. Unsuccessful treatment outcomes heighten the risk of disease transmission and the emergence of drug resistance. This research aims to identify the patterns of TB treatment outcomes and explore the determinants of unsuccessful treatment among newly diagnosed pulmonary tuberculosis (PTB) patients in Malaysia. Materials and methods: A retrospective cohort study analysed 39,117 new pulmonary TB cases from the National Tuberculosis Database (TBIS) between January 2018 and January 2022. Multiple logistic regression determined factors associated with unsuccessful outcomes, using significance at p-value < 0.05. Results: Among the patients, 84.9% reported successful treatment, while 15.1% had unsuccessful outcomes, attributed to death (59.1%), loss to follow-up (23.2%), and not evaluated (15.0%). Factors such as age over 40 years old, male sex, Indian ethnicity, no formal education, urban residency, unemployment, smoking, HIV status, absence of BCG scar, positive sputum smear, severe initial chest x-ray results, no DOT supervision, and passive case detection significantly increased the risk of unsuccessful treatment. Conclusion: The study highlights specific sociodemographic and clinical factors linked to unsuccessful TB treatment outcomes, suggesting the need for targeted interventions in TB control programs and risk assessment strategies.

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