High mortality among tuberculosis patients on treatment in Nigeria: a retrospective cohort study.
BMC Infect Dis
; 17(1): 170, 2017 02 23.
Article
en En
| MEDLINE
| ID: mdl-28231851
ABSTRACT
BACKGROUND:
Tuberculosis (TB) remains a leading cause of death in much of sub-Saharan Africa despite available effective treatment. Prompt initiation of TB treatment and access to antiretroviral therapy (ART) remains vital to the success of TB control. We assessed time to mortality after treatment onset using data from a large treatment centre in Nigeria.METHODS:
We analysed a retrospective cohort of TB patients that commenced treatment between January 2010 and December 2014 in Aminu Kano Teaching Hospital. We estimated mortality rates per person-months at risk (pm). Cox proportional hazards model was used to determine risk factors for mortality.RESULTS:
Among 1,424 patients with a median age of 36.6 years, 237 patients (16.6%) died after commencing TB treatment giving a mortality rate of 3.68 per 100 pm of treatment in this cohort. Most deaths occurred soon after treatment onset with a mortality rate of 37.6 per 100 pm in the 1st week of treatment. Risk factors for death were being HIV-positive but not on anti-retroviral treatment (ART) (aHR 1.39(1 · 04-1 · 85)), residence outside the city (aHR 3 · 18(2.28-4.45)), previous TB treatment (aHR 3.48(2.54-4.77)), no microbiological confirmation (aHR 4.96(2.69-9.17)), having both pulmonary and extra-pulmonary TB (aHR 1.45(1.03-2.02), and referral from a non-programme linked clinic/centre (aHR 3.02(2.01-4.53)).CONCLUSIONS:
We attribute early deaths in this relatively young cohort to delay in diagnosis and treatment of TB, inadequate treatment of drug-resistant TB, and poor ART access. Considerable expansion and improvement in quality of diagnosis and treatment services for TB and HIV are needed to achieve the sustainable development goal of reducing TB deaths by 95% by 2035.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Tuberculosis
/
Antituberculosos
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
País/Región como asunto:
Africa
Idioma:
En
Revista:
BMC Infect Dis
Asunto de la revista:
DOENCAS TRANSMISSIVEIS
Año:
2017
Tipo del documento:
Article
País de afiliación:
Nigeria