Factors associated with mortality of patients on antiretroviral therapy at the Andara district, Namibia
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Date
2014
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Abstract
Namibia, one of the countries hardest hit by HIV/AIDS, has embarked on a large scale public health sector roll-out of ART. The Catholic Health Services is implementing an HIV/AIDS treatment program in the Andara district since 2004. Even though there is strong evidence to show that antiretroviral therapy (ART) improves the survival and quality of life of people living with HIV/AIDS (PLWHA), an increased trend of mortality in patients on ART in the Andara district was observed, but there was no evidence to establish factors associated with such mortality.
The purpose of this study was to explore, describe and analyse factors associated with mortality of patients on ART in the Andara district. The objectives were to describe baseline socio-demographic and medical characteristics of patients on ART in the Andara district and to determine the independent risk factors associated with mortality of patients on ART on the Andara district. To direct this study, a null hypothesis and alternative hypothesis were formulated. A quantitative, analytical, case-control research design was applied, analysing patients’ records retrospectively. The population consisted of 913 medical records of HIV/AIDS patients aged from 15 years and older, who started ART in the Andara district between the 1st of August, 2004 and the 30th of September, 2009. Case population consisted of 196 adult patients who died and controls population consisted of 697 patients who were alive by the end of July 2011. All records of cases (who died) were taken and for each case, two controls were sampled (alive) to give the ratio of 1:2 using the simple random sampling method. Data was collected by means of a data abstraction tool (annexure A at page 138) developed by the researcher, based on the information in the standardised patient care booklet or patient file. Standardised patient files, registers and ART database (ePMS) were used to abstract data into a data abstraction tool. Data was entered into the Statistical Package for Social Science (SPSS) database. Data analysis involved both descriptive and analytical statistics. Descriptive statistics focus on the characteristic factors of patients such as socio-demographic factors, baseline information and medicine related factors. Analytical statistics in terms of Odds Ratios (OR), Confidence Intervals (CI), chi-square and P-value are presented to show associations between different variables and treatment outcomes. Strength of association is also indicated. This study was approved by the Postgraduate Studies Committee of the University of Namibia. Permission was sought from the Ministry of Health and Social Services Research and Ethics Committee, and from Catholic Health Services. This study concluded that sex, functional status, having a treatment supporter and anaemia are significant risk factors associated with death in the Andara district. The study also revealed that the ART regimen started was a protecting factor. There is a need for development of a guideline on revision of ART M&E tools in the Ministry of Health and Social Services. There is a need to strengthen health care workers’ adherence to ART guidelines, especially regarding the monitoring of patients on ART, as well as improving record keeping in the Andara district. Incomplete records, missing data and missing files limited the study. In addition, there are limited primary sources on the topic of factors associated with mortality of patients on ART.
Description
A thesis submitted in partial fulfilment of the requirements for the Degree of Master in Public Health.
Keywords
Mortality, Antiretroviral therapy, Andara