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)