A comparative analysis of tuberculosis treatment outcomes in varied healthcare settings during the COVID-19 pandemic: a case of first-level hospitals in Lusaka district, Zambia

Tuberculosis (TB) remains a major global health challenge, with over 10.6 million cases and 1 million deaths reported in 2022. The COVID-19 pandemic disrupted health service provision, including TB services, especially in low-and-middle-income countries (LMIC). Zambia, a LMIC in sub-Saharan Africa, bears a high burden of TB faced health service interruptions due to COVID-19. This study compared TB treatment outcomes between two first-level hospitals and assessed associated factors. This retrospective cross-sectional study used 2020 data from two purposively selected public first-level hospitals; Chawama and Chilenje in Lusaka District, Zambia. Data were systematically sampled from TB treatment registers, with sample sizes calculated using Cochran’s formula. Analysis involved descriptive statistics, chi-square tests, and multivariable logistic regression at a 95% confidence level using STATA version 14.2. Ethical approval was obtained from the University of Lusaka Ethics Committee and the National Health Research Authority (NHRA).Analysing 548 participants, males (65.2%) and those aged 25–34 (37.1%) were predominant. Chilenje demonstrated a higher proportion of favourable TB treatment outcomes (90.6%) compared to Chawama (83.3%). Patients from Chilenje were twice as likely to have favourable outcomes (OR = 1.933; p = 0.016). When considering factors like age, HIV status, TB type, patient type, and DOT plan, Chawama patients aged 65+ were 71.9% less likely to have favourable outcomes (AOR = 0.281; p = 0.047), whereas at Chilenje, those aged 25–34 were 3.9 times more likely (AOR = 3.869; p = 0.046), and those aged 35–44 were 5.1 times more likely (AOR = 5.111; p = 0.040) compared to those aged 15–24. This study found disparities in TB treatment outcomes between Chawama and Chilenje hospitals during COVID-19, with Chilenje showing better success rates. Differences were linked to facility-level factors and age, with poorer outcomes among the elderly and youth. Recommendations include reallocating resources, strengthening DOTS, targeted support for vulnerable groups, staff training, and adopting pandemic-resilient strategies to improve TB care in Zambia.