Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia

PLOS ONE, Dec 2019

Background Tuberculosis (TB) is among the leading causes of morbidity and mortality worldwide. More than 70% of the deaths of TB patients occur during the first two months of TB treatment. The major risk factors that increase early death of TB patients are being positive for human immunodeficiency virus (HIV), being of old age, being underweight or undergoing re-treatment. Objective To assess the time of reported deaths and associated factors in a cohort of patients with TB during TB treatment. Methods An institution-based retrospective cohort study was analyzed in Dangila Woreda, Northwest Ethiopia from March 1st through March 30, 2014. All TB patients registered in the direct observed treatment (DOTs) clinic from 2008–2012 were included in the study. Data were entered into EpiData and exported to SPSS for analysis. The survival probability was analyzed by the Kaplan Meier method and Cox regression analysis was applied to investigate factors associated with death during TB treatment. Results From a total of 872 cases registered in TB registry log book, 810 were used for the analysis of which 60 (7.4%) died during the treatment. The overall mortality rate was 12.8/1000 person months of observation. A majority of TB deaths 34 (56.7%) occurred during the intensive phase of the treatment, and the median time of death was at two months of the treatment. Age, HIV status and baseline body weight were independent predictors of death during TB treatment. Conclusions Most deaths occurred in the first two months of TB treatment. Old age, TB/HIV co-infection and a baseline body weight of <35 kg increased the mortality during TB treatment. Therefore, a special follow up of TB patients during the intensive phase, of older patients and of TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment.

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Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia

December Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia Abayneh Birlie 0 1 Getnet Tesfaw 0 1 Tariku Dejene 0 1 Kifle Woldemichael 0 1 0 Editor: Philip C Hill, University of Otago, NEW ZEALAND 1 1 Department of Monitoring and Evaluation, Addis Ababa City Administration Health Bureau , Yeka Sub-City, Addis Ababa , Ethiopia , 2 Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University , Jimma , Ethiopia , 3 Department of Statistics, College of Natural Sciences, Addis Ababa University , Addis Ababa , Ethiopia , 4 Department of Epidemiology, College of Health Sciences, Jimma University , Jimma , Ethiopia Results From a total of 872 cases registered in TB registry log book, 810 were used for the analysis of which 60 (7.4%) died during the treatment. The overall mortality rate was 12.8/1000 person months of observation. A majority of TB deaths 34 (56.7%) occurred during the intensive phase of the treatment, and the median time of death was at two months of the OPEN ACCESS Data Availability Statement: All relevant data are within the paper. Funding: This work was funded by Jimma University Postgraduate Coordination Office, www.ju.edu.et. The funding was received by AB. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Background Objective Methods treatment. Age, HIV status and baseline body weight were independent predictors of death during TB treatment. Conclusions Most deaths occurred in the first two months of TB treatment. Old age, TB/HIV co-infection and a baseline body weight of <35 kg increased the mortality during TB treatment. Therefore, a special follow up of TB patients during the intensive phase, of older patients and of TB/HIV co-infected cases, as well as nutritionally supplementing for underweight patients may be important to consider as interventions to reduce deaths during TB treatment. Introduction Tuberculosis is a chronic mycobacterial infection present in all parts of the world [1]. About a third of the world’s population are estimated to be infected with M. tuberculosis, albeit mostly without clinical symptoms. These silent carriers bear a life time risk of developing active disease [2, 3, 4], with more than 95% of cases and deaths occurring in the developing world [4, 5]. TB kills nearly 2 million persons per year worldwide. It is still one of the leading causes of death in the world accounting for 2.5% of the global burden of diseases and 25% of all avoidabledeaths-in-developing-countries-[1]. Ethiopia ranks 8th among 22 high burden countries in the world, and is 2nd in Africa behind South Africa in 2012. The mortality rate was 18/100,000 population in 2012 [6]. According to the Ethiopian Ministry of Health 2008 report, TB is the leading cause of morbidity, the third cause of hospital admissions and the second cause of death [7]. The national population based TB prevalence survey in 2010/11 revealed that the prevalence of bacteriologically confirmed cases was 156 and the prevalence of all forms of TB cases was 240 /100,000 population [8]. Based on the WHO report of 2013, Ethiopia had an estimated number of 247 new TB cases and 224 prevalence cases/100,000 population in 2012 [9]. Patients diagnosed with TB are referred to “directly observed treatment (DOTs)” clinics and start TB treatment after being classified into one of the treatment categories. They take a combination of drugs for 6 to 8 months based on the national TB treatment guideline. The final outcomes of the TB treatments are classified as (i) cured, (ii) treatment completed, (iii) treatment failure, (iv) died, (v) defaulters, (vi) transferred out and treatment outcome is unknown [2, 3]. The treatment success rate was improved after the introduction of the DOTs program. According to the 2013 WHO report, the global treatment success rate was 87%, which is the fifth successive year in which it exceeded from the target 85%. The overall TB treatment success rate in Africa was 82%, with steady improvements since 1999 and showing hope to achieve the MDG goal. Death of patients during TB treatment is among the possible reasons for low treatment success rate [8]. The global TB mortality rate was 29/100,000 population in 1990 and increased to 32/100,000 population in 2000 before falling to 18/100,000 population in 2012. WHO has set the goal to reduce TB mortality below 15/100,000 population by 2015 [8, 10, 11, 12]. Globally, there were an estimated 1.3 million TB deaths in 2012, with 75% occurring in Africa and Southeast Asia. The mortality rate of TB was 13/100,000 population, but 17.6/ 100,000 population when HIV-positive patients were included in 2012 [6]. In Ethiopia there were an estimated 16,000 TB deaths with a mortality rate of 18 /100,000 population [8]. Accordin (...truncated)


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Abayneh Birlie, Getnet Tesfaw, Tariku Dejene, Kifle Woldemichael. Time to Death and Associated Factors among Tuberculosis Patients in Dangila Woreda, Northwest Ethiopia, PLOS ONE, 2015, Volume 10, Issue 12, DOI: 10.1371/journal.pone.0144244